Weight Loss Surgeryhelping you make the right choice

What causes obesity? 3

Are you eligible for surgery? 4– suitable candidates for weight loss surgery

– what is weight loss surgery?

– body mass index

– waist measurement

The surgical procedures 6– gastric banding (Beacon Hospital)

– gastric bypass

Important information 8– how to access surgery

– an inclusive package

– what are the risks of surgery?

What happens after surgery? 9

A life changing experience 10

– changing the way you eat

– how will your life change?

– how much weight will you lose?

Contents

1

If you have tried everything to lose weight, but can’t, then weight loss surgery at Beacon Hospital could be the answer.

But it is not a quick fix, or an easy option. This booklet provides information that will help you understand the process, the implications and the risks involved. It should help you prepare for your next step in your weight loss journey.

You’ll receive care and support from a team of specialists

before, during and after surgery.

Please note:

This brochure is solely a guide to those who may be interested in obesity surgery

procedures, and as such all information here is of a general nature. It cannot be a

substitute for a consultation with a specialist doctor or surgeon in conjunction with your

GP, as individual expectations can vary. The final decision to carry out a procedure is

at the consultant’s discretion, based on comprehensive assessment by the multi-

disciplinary team of specialists.

Surgery can provide a weight loss solution for people who have a large amount of weight to lose, and who have been unable to lose weight by other methods.

2

What causes obesity?

1. Energy balance

Your body needs the energy that comes from the

food you eat in order to function properly and

remain healthy. When you eat the same amount of

food that your body needs, your weight stays the

same.

If you get more energy from your food than you

need, some is left over. Your body stores that extra

energy as fatty tissue. If your body never uses the

extra fat, you will gain weight.

2. Hereditary

If others in your family are obese, then you have a

higher risk for obesity.

3. Metabolic disorders

Changes in metabolism, or how your body gets

energy from food, may affect your energy balance

and your weight. For example, an underactive

thyroid gland may result in weight gain.

4. Eating and social habits

Eating an unbalanced diet, snacking between

meals and not getting enough exercise, may all

contribute to obesity.

5. Psychological factors

Social or emotional eating is also one of the main

causes of gaining weight.

Any one or a combination of these factors can

lead to obesity. As science continues to search for

answers, obese individuals must understand how

to treat their condition in the most effective way.

Part of your initial assessment would be to confirm

your suitability for treatment. Using the chart on

page 5 will help you to decide whether you require

surgery or non surgical treatment. Not everyone

who has a weight problem should consider surgery

– your own particular Body Mass Index (BMI) will

determine whether you are overweight, obese or

morbidly obese.

Many things can lead to obesity. The five main causes are listed below:

3

Eating an unbalanced diet,

snacking between meals and

not getting enough exercise

may all contribute to obesity.

Are you eligible for surgery?

4

There are two main ways of establishing if you may be eligible for surgery. The first uses your height and weight to calculate your Body Mass Index (BMI), and the second simply uses your waist measurement...

1.93

1.91

1.88

1.85

1.83

1.80

1.78

1.75

1.73

1.70

1.68

1.65

1.63

1.60

1.57

1.55

1.52

1.50

1.47

Height (m)

63 65 68 70 72 74 77 79 81 83 86 88 90 92 95 97 99 101 104 106 108 110 113 115 117 120 122 124 127 129

Weight (kgs)

Heig

ht (

ft/i

n)

6' 4"

6' 3"

6' 2"

6' 1"

6' 0"

5' 11"

5' 10"

5' 9"

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140 145 150 155 160 165 170 175 180 185 190 195 200 205 210 215 220 225 230 235 240 245 250 255 260 265 270 275 280 285

Weight (lbs)*

11 stone 12 stone 13 stone 14 stone 16 stone 17 stone 18 stone 19 stone 20 stone10 stone

4 1

OK overweight

*There are 14 pounds (lbs) in a stone

obese

potential candidate for surgeryBMI ≥ 35

Suitable candidates for obesity surgery

An ideal BMI is 19 to 25. If your BMI is between

25 and 30, you are thought to be overweight. If it

is higher than 30, you are obese. That means you

are at risk of health problems. Your BMI is the best

indicator and if your BMI is 35 or more, surgery

might be a suitable approach.

For people with a BMI between 35 and 40 who have

conditions associated with obesity, for instance

sleep apnoea, diabetes mellitus, or heart problems,

your doctor might suggest surgery to help you lose

weight. Patients whose BMI’s fall between 30-35,

who do not qualify for surgical intervention, may be

suitable for weight management programmes. Please

discuss this option with your GP.

5

What is weight loss surgery?

Weight loss surgery reduces the amount of food

you can eat by reducing the size of your stomach

or bypassing it. There are two main types of

operation, gastric banding and gastric bypass. Your

consultant surgeon will discuss the options with

you and decide which would suit you and your

lifestyle.

The surgery practiced at Beacon Hospital is the

former, gastric banding, which is the less invasive

form. It’s important to remember that surgery is

only part of the solution. You will need to meet

certain criteria in order to be eligible for surgery.

You will also need to change what you eat and

increase your exercise levels following surgery. But

don’t worry, you will have a team of people here at

Beacon Hospital to help you.

Body Mass Index

Your BMI is a measure of body fat based on height

and weight. It is calculated by taking your

weight in kilograms divided by your height

in metres squared.

The chart below calculates your BMI for you. You

may be eligible for surgery if your BMI is over

40, or if it is over 35 and you have other medical

conditions.

Waist measurement

Excess weight, as measured by BMI, is not the only

risk to your health. The location of stored fat can

also indicate an increased risk. Carrying fat mainly

around your waist suggests you are more likely

to develop health problems than if you carry the

weight on your hips and thighs.

A very simple indication that you may be

eligible for surgery is your waist measurement.

Men with a waist measurement of over 40 inches

and women with a waist measurement of over

35 inches may be eligible for weight loss surgery.

1.93

1.91

1.88

1.85

1.83

1.80

1.78

1.75

1.73

1.70

1.68

1.65

1.63

1.60

1.57

1.55

1.52

1.50

1.47

Height (m)

63 65 68 70 72 74 77 79 81 83 86 88 90 92 95 97 99 101 104 106 108 110 113 115 117 120 122 124 127 129

Weight (kgs)

Heig

ht (

ft/i

n)

6' 4"

6' 3"

6' 2"

6' 1"

6' 0"

5' 11"

5' 10"

5' 9"

5' 8"

5' 7"

5' 6"

5' 5"

5' 4"

5' 3"

5' 2"

5' 1"

5' 0"

4' 11"

4' 10"

140 145 150 155 160 165 170 175 180 185 190 195 200 205 210 215 220 225 230 235 240 245 250 255 260 265 270 275 280 285

Weight (lbs)*

11 stone 12 stone 13 stone 14 stone 16 stone 17 stone 18 stone 19 stone 20 stone10 stone

4 1

OK overweight

*There are 14 pounds (lbs) in a stone

obese

potential candidate for surgeryBMI ≥ 35

1.93

1.91

1.88

1.85

1.83

1.80

1.78

1.75

1.73

1.70

1.68

1.65

1.63

1.60

1.57

1.55

1.52

1.50

1.47

Height (m)

63 65 68 70 72 74 77 79 81 83 86 88 90 92 95 97 99 101 104 106 108 110 113 115 117 120 122 124 127 129

Weight (kgs)He

ight

(ft

/in)

6' 4"

6' 3"

6' 2"

6' 1"

6' 0"

5' 11"

5' 10"

5' 9"

5' 8"

5' 7"

5' 6"

5' 5"

5' 4"

5' 3"

5' 2"

5' 1"

5' 0"

4' 11"

4' 10"

140 145 150 155 160 165 170 175 180 185 190 195 200 205 210 215 220 225 230 235 240 245 250 255 260 265 270 275 280 285

Weight (lbs)*

11 stone 12 stone 13 stone 14 stone 16 stone 17 stone 18 stone 19 stone 20 stone10 stone

4 1

OK overweight

*There are 14 pounds (lbs) in a stone

obese

potential candidate for surgeryBMI ≥ 35

Gastric Banding

Gastric banding, sometimes known as ‘lap

banding’ is a highly effective procedure to help

overweight people achieve substantial and long-

term weight loss.

The operation limits how much food you can eat.

An inflatable band is placed around the stomach

to divide it into two parts. This creates a smaller

pouch at the top, which takes less food to make

you feel full. The food then passes slowly through

the opening left by the band and into the lower

part of your stomach and continues on as normal.

The band can be inflated by injecting fluid

to reduce the size of the opening into the lower

part of the stomach. This will restrict the amount

of food you can eat even further and make you

feel fuller for longer.

The band is inserted laparoscopically, through

four or five small incisions. This is sometimes

referred to as keyhole surgery. Adjustments to

the band are made by injecting fluid through a

very small tube which has a special button-like

reservoir just under your skin. It can be inflated

and deflated in this way, until the right level of

restriction is established. This may take several

visits to the hospital over a period of several

months following surgery.

band around stomach (inflatable)

small stomach pouch

stomach

reservoir

Gastric Banding

Summary of information:

• Usually for patients with a Body Mass Index (BMI) of under 55

• Hospital stay of one (or at most two) nights

• Recovery time approximately 2 weeks

• A reversible procedure

• Repeated visits to hospital required to adjust band

• Average weight loss – 55% of excess weight1

The surgical procedures

6

There are two main types of weight loss surgery. These are gastric banding

and gastric bypass. Gastric banding, which is carried out in Beacon Hospital,

is suitable for most patients with a BMI between 35 and 55.

Gastric Bypass

A gastric bypass is also a highly effective procedure.

It helps very overweight patients to achieve

substantial and permanent weight loss. It does

this by restricting the amount you can eat, and by

reducing the amount of calories absorbed from the

food that you do eat.

The operation creates a small stomach pouch in the

same way as the gastric band. But instead of the

food passing into the stomach through the band,

it bypasses the stomach and much of the intestine

through a section of the small intestine that has

been re-routed and grafted onto the stomach.

The procedure can be carried out laparoscopically

(by keyhole surgery) through five or six small

incisions. It can also be carried out as an open

operation with one vertical incision in the abdomen.

Which operation is right for you?

Your surgeon will discuss all the options with you and establish which operation is most suitable for you and your individual needs. The tables below show some key points for each type of operation.

Please note that currently Beacon Hospital

offers gastric banding only.

gastric pouch

small intestine

bypassed small intestine

bypassed portion of stomach

staples

Gastric Bypass

Summary of information:

• Results in greater, more permanent weight loss

• Major surgery with greater risks of complications

• Hospital stay of three to six nights

• Recovery time approximately six weeks

• Not easily reversible

• Lifelong nutrient supplement required

• Average weight loss – 70% of excess weight2

7

How to access surgery – gastric banding in Beacon Hospital

Please visit your GP, who will, if appropriate, refer

you to the programme in Beacon Hospital. In the

hospital your consultant will talk through the

procedures with you in detail, perform a detailed

medical assessment and decide the best route for

you. They will also take you through the detailed

aftercare programme in place to take care of you

following surgery.

An inclusive package

To give you peace of mind, we offer a fixed price

package so that you know exactly how much your

operation will cost, before you have surgery. This

includes all initial consultations, surgery, follow-

up consultation and support from our team of

experts. There are no hidden extras. The initial

assessment is free of charge, so you don’t need to

pay anything if you decide not to go ahead with

surgery.

What are the risks of surgery?

Most people get through their operation with few

problems. But, as with any surgery, there are risks

of serious complications such as heart attack or

blood clots. Though it is very rare, there is a risk

of not surviving the operation. More common

complications include wound and chest infections.

It is important that you understand the risks fully

before you agree to proceed with an operation.

Your consultant will make sure you have all the

information you need to help you make your

decision.

Important information

8

After surgery

After gastric banding, you will stay in hospital for

one night. Your consultant will visit you during

this time, and you will be looked after by a team

of professional nursing staff, on-hand whenever

you need them.

Recovery time

Weight loss surgery is a major operation, so it is

important that you take time to recover. You are

likely to feel tired and need rest when you get

home. You may need someone at home to help

you, and you will need to take time off work.

You can expect to be back to normal within two

weeks of surgery for a gastric band. But everybody

is different, and your consultant and specialist

team will help you decide when you are

ready to return to your normal activities.

Your diet following surgery

Immediately following surgery you may not be

able to digest food properly. So you will be put on

a diet of liquid food to start with. You will then

need to eat soft or puréed food for a few weeks

before you can move onto solid food. Your

dietician will give you guidance on how

to increase your intake gradually as eating solid

food before you are ready could result in pain

or vomiting.

What happens after surgery?

9

Weight loss surgery can help to improve your health and general well being.

A life changing experience

10

Changing the way you eat

Weight loss surgery works by reducing the amount

of food you can eat. You will no longer be able to

eat in the same way that you do now. Portion sizes

will be much smaller and you will need to eat

each meal slowly, sitting at the table in an upright

position. You will need to chew much more

thoroughly and restrict your fluid intake during

meals.

There may be some foods that you are not able to

eat in the long term. These include white bread,

boiled rice, pasta, meat chops, steak, nuts and

fibrous fruits and vegetables such as oranges,

pineapples, green beans and mushrooms. Eating

too much, choosing the wrong type or texture of

food, or eating too quickly could cause vomiting.

(If you have had a gastric bypass you will need

to take a chewable or dissolvable multi-vitamin

every day for the rest of your life, to make sure you

are receiving all the essential nutrients you need).

If you regularly organise meals for other family

members, you may not be able to eat the same

sort of food as them. Whilst they may eat their

meal on a dinner plate, your portion will be small

enough to fit on a tea plate. If you go out to

dinner, your meal will be equivalent to a starter

size rather than a main meal. And if you have

takeaways, you will find these portion sizes are far

too large, and you may not be able to eat the type

of food available.

You will have regular one to one meetings with

your dietician who will help you through any

problems you are having and manage your diet

with you. Your dietician will give you ongoing

personal support to help you manage your diet

following surgery.

Please remember that best results will only come about with a partnership approach between you and the medical team here at Beacon Hospital.

We will provide the surgery and all the advice you will need – and you will need to take our dietary advice and exercise as appropriate.

11

How will your life change?

The result of weight loss surgery should help

to improve your general wellbeing. You should

be able to undertake more physical activity and

many patients find their self-confidence increases.

Patients are often more inclined to socialise and

spend more time out with their friends and family.

Your general health should improve with the

weight loss and increased activity. You will be

less at risk of obesity related diseases such

as heart disease, high blood pressure, cancer

and diabetes. If you already suffer from these

complaints, then the pattern of their disease

should slow down or stop completely after time.

How much weight will you lose?

The partnership between the gastric band

on one hand, and your healthy eating choices

and activity levels on the other, is very important

in order to maximise your weight loss after

surgery.

Everybody is different, so it is difficult to

predict exactly how much weight you would

lose. Weight loss is also dependent on your weight

before surgery, your food choices and the amount

of exercise that you do.

On average people who undergo a gastric banding

operation lose around half of their excess weight

within two years of surgery.

Your dietician will give you ongoing personal support to help you manage your diet following surgery.

References:

1. BMJ Obesity surgery, Gastric Banding, Jan 2006

2. Colquitt J, Clegg A, Sidhu M, Royle P. Surgery for morbid obesity. Oxford: The Cochrane library 2004. No. 3

Weight loss surgery can help to improve your health and general well being.

Consultant profile

Consultant name: Mr Robert C Stuart

Qualifications: MB ChB BAO FRCSI MCh FRCS (Gen)

FHKCS FRCPS (Glas)

Background information: • Qualified University College Dublin 1982

• Senior Lecturer & Consultant Surgeon, Glasgow Royal Infirmary

1995-2006

Major clinical interests and subspecialty: • General surgery, upper gastrointestinal surgery, laparoscopic

surgery, therapeutic endoscopy

• Clinical expertise in surgery and endoscopy for benign and

malignant diseases of the upper gastrointestinal tract with 15 years

experience in open and laparoscopic weight loss surgery and is

currently an EAES trainer in advanced laparoscopic and bariatric

surgery

• Introduced laparoscopic gastric stapling and bypass to Scotland

• Specific clinical interests include laparoscopic surgery for morbid

obesity, laparoscopic antireflux surgery, laparoscopic surgery for

achalasia and therapeutic endoscopy

• Research interests include bariatric surgery, Barrett’s oesophagus

and the role of inflammation in oesophageal cancer

Specific bariatric surgery training: • Advanced gastrointestinal laparoscopic fellowship with Prof SCS

Chung, Hong Kong 1992-93

• Open bariatric surgery with Prof J Baxter (Treasurer of BOSS)

Glasgow 1995-97

• Laparoscopic gastric bypass and banding with Mr Simon Dexter and

Prof McMahon, Leeds 2000

Professional memberships: • Member of BOSS, AUGIS and EAES

• Registered on the Specialist Register

Other relevant information: www.beaconhospital.ie

www.sosurgery.co.uk

Email: obesitysurgery@mac.com

Beacon Hospital

Sandyford, Dublin 18

TEL +353 1 293 8684 FAX +353 1 293 6601

www.beaconhospital.ie