Surgical treatment of obesity
Size of the problem
Associated Morbidities
• DM• Sleep apnoea• HT• Pulmonary failure
– Depression
• Arthritis
• Heart Disease• Stroke• Hernias• Reflux• Stress incontinence• Pulmonary
embolism
Metabolic Syndrome
• HT
• Insulin resistance
• Dyslipidaemia
• Cardiovascular disease
• (Sleep apnoea)
Obesity in NZ and Auckland• Obesity: increasingly common in adults
– 1989 11%– 1997 17% – 2002 21%1– 2006/7 25%
• In ADHB, over 8000 adults have BMI over 40
– 12006/7 New Zealand Health Survey– 2www.moh.govt.nz/obesity
Morbid obesity in NZ prevalance
International comparison NZ 25% v Median OECD 13%
Self reporting of obesity 28th (30) Actual Data 2nd (6) USA 34% UK 24% Australia 22% The Other two Japan & Korea 4%
Morbid obesity in NZ prevalance
• Prevalance related to social deprivation
• Quintiles– 5 38%– 4 26%– 3 23%– 2 21%– 1 21%
Obesity and life expectancy
What is the best way to manage severe obesity? Exercise / Drugs
What is the best way to manage severe obesity? Diet
Bariatric Surgery Today
Adjustable Band Gastroplasty
Restrictive
Roux en Y Gastric Bypass
Combination
Biliopancreatic Diversion w/ Duodenal Switch
Malabsorptive
What do we do?External Referral Internal Referral
Meets criteria
Yes No Return to referrer
Patient discharged
Patient attends Bariatric seminar
Patient completes
questionnaire
MDT discussion
Patientaccepted onto
programme
Further investigation
required
Patient declined - return to GP
Patient discharged
New patients
Discussion• Criteria• Dietetics• Gastroscopy• Weight loss• Psyche• Perioperative management• Politics• Audit• Research
Discovery• I can cross my legs!• I have to tighten the airplane
belt• I have collar bones• I can walk through a turnstile• No more sympathetic looks in
the • boutique clothes shops• Stunned looks• I did a half marathon!
She did the Marathon
Outcomes of Gastric Bypass
– Weight loss– Improvement in illnesses– Change in life expectancy– Quality of life
Weight Loss• Rate of weight loss 1-2kg/wk
• Mean EWL 60-70%*• eg patient at weight 140kg, with IBW 70kg• expect average final weight: 91-98kg (loss of
42- 49kg)
• Failure (<50% EWL) 1/12
• Data Maturity 15 yrs
Improvement in illnesses
• Type 2 Diabetes 83.7%
• High Blood Pressure 75.4%
• High Cholesterol 93.6%
• Obstructive Sleep Apnoea 86.6%
Change in Life Expectancy
• Overall, life expectancy significantly improved• Reduced heart disease and
cancer
• Chance of death due to the operation: • 1 in 100 to one in 300• (similar to the risk with a knee
replacement)
Eating and Quality of life• Entrée sized meals
• “Taste buds change”: Normal diet• Healthy foods taste better• Dumping with fats &
sweets• Supplements: required lifelong• Multivite• B12, Fe Ca
Outcomes -Diabetes