Surgical Managementof Obesity

Obesity is the great epidemic

of the 21st century

How do we Grade obesity?The most useful measure is BMI : Wt (Kilograms) / Height (Metres) 2

>This is a measure of both weight and height

>It takes into account that the taller you are:

>The more weight you can safely carry

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+

Australia is the second most obese nation in the world

> 50% Australians are overweight BMI 25-30

> 8% Australians are obese BMI 30-35

> 2-4% Australians are Morbidly obeseBMI 35 +

“ Average “ Australian weight increasing by 0.5Kg / 5yrs

Obesity is a major cause of these obesity related illness> Type 11 Diabetes> Hypertension> Sleep apnoea> Asthma> Infertility> Arthritis> Fatty liver

>The good news is… All of these conditions will resolve or improve with significant weight loss

For the first time this century>Our children will live less long than us

>Diabetes rates are skyrocketing

>Children as young as 12 are taking the same tablets for diabetes as their Grandmothers

…all because of Obesity

> Low self esteem and depression.

> Impaired employment prospects.

> Increased industrial accidents.

> Restricted access to public facilities.

> Relationship difficulties.

> Societal prejudice.

Societal implications of obesity

Body Mass Index vs. Mortality

16 19 22 25 28 31 34 37 40 45

0

50

100

150

200

250

300

350

400

High riskMedium riskLow risk

Rela

tive M

ort

ality

R

ate

BMI (kg/m2)

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!

Obesity is not just an eating disorder!

>It is a complex relationship between

>Genetic predisposition

>Increased caloric intake

>Reduced caloric expenditure

>We all live in a “Toxic Obesogenic” environment !

Excess Caloric Intake

Morbid Obesity

Genetic predisposition

Reduced Caloric expenditure

DepressionLow self esteem

Failed dietsFailed Medical Rx

Obesity illnesssyndrome

Australians spend millions of dollars each year on dietsFor the majority of morbidly obese ……Diets just don’t work

“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.

Tried…and abandoned

> Jaw wiring > Hypnosis > Acupuncture > Psychotherapy > VLC diets > Intragastric balloon

And then there is always

Most medical authoritiesnow agree

>The most effective treatment of

Morbid obesity… is surgery

>It is safe, effective and durable!

Bariatric surgery is not just about the surgery!

>The best results are achievedwith a Multidisciplinary team

>Surgery is an aid to weight loss

> It still requires effort andcommitment by the patient

At Mercy Bariatrics we have developed:

>A dedicated Bariatric team of health professionals

>Diet and exercise programmes to compliment the surgical procedures

>Educational and support services to guide you through the surgical programme

Obese Patient

BariatricSurgeon

BariatricAssessor

SurgicalAssistant

Office staff Exercise Physiologist

Physician

DieticianAnaesthetist

Psychologist

Who is a candidatefor surgery?

> BMI > 35> BMI > 30 -35 + Obesity Co-morbidity

> Age 12- 75> Reasonable attempts at weight loss >2yrs> Ability to comprehend implications of

Surgery> No Alcohol or Drug Dependency

Surgical Choices

> There are many different operations for obesity.

> There is no single operation which is right for all

people

> Each operation has advantages and disadvantages

> Choosing the right operation is the most important

step towards successful outcomes.

> At Mercy Bariatrics we have focussed on three main

types of surgery.

Lap band>A reductive and restrictive operation

>Adjustable silicone band

>Placed around top part of stomach by keyhole surgery

>Decreases intake to an entrée portion

>Prolongs satiety and decreases appetite

>2 days in hospital back at work in < 1 week

>Safe, reliable, effective

>Over 20, 000 procedures throughout Australia

Usual weight loss: 50-60% of excess weight lost over 1-2yrs

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Laparoscopic Tube Gastrectomy

> A purely reductive operation

> Reduces stomach to a 150-200mls tube

> Normal emptying so you can eat a wider range of food

> A set and forget operation> No adjustments required> No malabsorption> No long term side effects> Bypass can be added later

for extra weight loss

Predicted weight loss: 50-70 % EWL over 1-2 years

Biliopancreatic Bypass - DS

> A reductive and Fat malabsorbtion operation

> Profound and rapid improvement in diabetes and high cholesterol

> Open surgery so requires longer to recover

> Best weight loss of all procedures

> Good revisional option> Lifelong mineral and vitamin

supplements required

Predicted weight loss: 70-90% EWL over 1-2 years

Results from surgery…>Type 11 diabetes resolved in 70-90%

>Hypertension resolved in 70-80%

>Sleep apnoea resolved in 80-90%

>Asthma improved in 70%

>Significant improvement in Depression and quality of life scores

80% of our patients achieve more than 50% of excess weight loss over 2years.

Our patients tell the story…

Lap Band 100.7kgBMI 39.7

Post op 12months

79kgBMI 30.5

Pre op Lap Band Wt 105kg

Post op 2 yearsWt 64kg

Preop Abdo lipoplasty and Lap bandWt 160kg BMI 52

18 Months Post op 107kgBMI 35-53kg / 59% EWL

Laparoscopic tube Gastrectomy

Preop Jan 2004144kgBMI 45

Jan 200587kg / BMI 27

Pre op 152kg Post op 1 year 92kg

Tube Gastrectomy

Preop BPD 174kgBMI 58

24months

74kgBMI 24 - 100kg

96%EWL

Preop 127kgBMI 43

Post op 84 weeks82kgBMI 27

Biliopancreatic Diversion

Preop BPDOct 2001Wt 146kg

BMI 56

Post op BPDJan 2003Wt 85kgBMI 31

Preop 189kg 2 yrs / Post op 109kg

Biliopancreatic Bypass

Preop 118kg Post op / 18 months / 65kg

Preop Lap BPDSept 2003Wt 122KgBMI 40

Postop Jan 2005Wt 72Kg (-50Kg 92% EWL)BMI 24

How do I get started?

>Talk to your G.P. about the surgical options>Attend one of our free information evenings>Visit us at Mercy Bariatrics>Check out our website

>www.mercybariatrics.com.au