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Managing Obesity in Adults
“Laparoscopic gastric band surgery, a partnership in sustained weight
loss”
Recent advances in surgical treatment for obesity
69 Lake Rd, Port Macquarie NSW
Dr George Petrou BSc (Med) MBBS FRACS
www.portlapsurgery.com.au
Obesity: Definition
• Imbalance between calorie intake & expenditure
• BMI (body mass index) = weight/height2
BMI > 25 = overweight (>50% adults)
BMI > 30 = obese (20% adults)
BMI > 35 = severe obesity (8% adults)
The most common chronic illness in the Western world
The increase in severe obesity (USA)
Sturm R. Arch Intern Med 2003;163(18):2146-8.
The weight problem in Australia today
NORMAL
BMI 18.5 – 24.9
OVERWEIGHT
BMI 25 – 29.9
Class I
BMI 30 – 34.9Class II
BMI 35 – 39.9
Class III
BMI 40
45% 4% 6%33% 12%
1:10 of the Australian adult community may have a BMI >35
BEACH 2003-2004 the Australian adult population data consistent with AUSDIAB data
Health Risks and Increased Risk of Mortality
Diabetes
Hypertension
Sleep apnea
Depression
Joint pain
Infertility
Cancer
Acid reflux
Asthma
Calle EE, Michael MJ, Petrelli JM, et al. Body-mass index and mortality in a prospective cohort of US adults. N Eng J Med. 1999;341(15):1097-105.
Flegal KM, Graubard, B. I., Williamson, D.F., Gail, M.H. Excess deaths associated with underweight, overweight and obesity. JAMA. April 20, 2005 2005;293(15):1861-1867.
0
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400
16
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32
34
36
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40
44
High risk
Medium risk
Low risk
Diseases Attributable to ObesityRelative Risk of Developing Certain Diseases Over the
Next Decade For Men With BMI >351
0
10
20
30
40
50
Rel
ativ
e R
isk
Diabetes High Blood
Pressure
Heart Disease Stroke
1. Lopes HF, Egan BM. Autonomic dysregulation and the metabolic syndrome: Pathologic partners in an emerging global pandemic. Arq Bras Cardiol. 2006;87:489-498.
BMI & death
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350
4001
6
18
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44
High risk
Medium risk
Low risk
Does Weight Loss Make a Difference?
Impact of Weight Loss on Risk Factors ~5%
Weight Loss
5%-10%
Weight Loss
HbA1c
Blood Pressure
Total Cholesterol
HDL Cholesterol
Triglycerides
1. Wing RR, Koeske R, Epstein LH, et al. Long-term effects of modest weight loss in type II diabetic patients. Arch Intern Med. 1987;147(10):1749-53. 2. Mertens IL, Van Gaal LF. Overweight, obesity, and blood pressure: the effects of modest weight reduction. Obes Res. 2000;8(3):270-8. 3. Blackburn G. Effect of degree of weight loss on health benefits. Obes Res. 1995;3 Suppl 2:211s-216s. 4. Ditschuneit HH, Frier HI, Flechtner-Mors M. Lipoprotein responses to weight loss and weight maintenance in high-risk obese subjects. Eur J Clin Nutr. 2002;56(3):264-70.
1
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1
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-20
-15
-10
-5
0
5
Short-term Obesity Therapy Does Not Result in Long-term Weight Loss
C
ha
ng
e in W
eig
ht
(kg)
Source: Wadden TA, Sternberg JA, Letizia KA, et al. Treatment of obesity by very low calorie diet, behavior therapy, and their combination: a five-year perspective. Int J Obes. 1989;13 Suppl 2:39-46
5-YearFollow-up
End ofTreatment
Baseline
Diet alone
Behavior therapy
Combined therapy
Weight loss sustained with surgery!
0
5
10
15
20
25
30
0 1 2 3 4 5 6 7 8
Dieting
Exerscise
Diet and exercise
Diet exercise and
drugs
Surgery
Year
weight loss
%
Resolution of Diabetes: Recent Data
0%
20%
40%
60%
80%
100%
Pontiroli,
5 yr
Ahroni,
1 yr
Spivak,
1.5 yr
Ponce,
2 yr
Dixon,
1 yr
Torquati,
1 yr
Skroubis,
2 yr
Pories,
2 yr
White,
4 yr
Study
% R
es
olv
ed
RYGB
LAGB
Pontiroli AE et al. Diabetes Care. 2005;28:2703-2709. Ahroni JH et al. Obes Surg. 2005;15:641-647. Spivak H et al. Am J Surg.
2005;189:27-32. Ponce J et al. Obes Surg. 2004;14:1335-1342. Dixon JB, O'Brien PE. Diabetes Care. 2002;25:358-363.
Torquati A et al. J Gastrointest Surg. 2005;9:1112-1118. Skroubis G et al. Obes Surg. 2006;16:488-495. Pories WJ. Presented at:
NAASO-The Obesity Society Annual Scientific Meeting; October 20-24, 2006; Boston, Mass. White MA et al. Obes Res.
2004;12:949-955.
Most Common Surgical Options
Gastric Bypass (GBP)
The LAP-BAND® System Adjustable Gastric Banding
Sleeve Gastrectomy (SG)
The LAP-BAND ® System
Am I a candidate for Surgery?
NORMAL
BMI 18.5 – 24.9
OVERWEIGHT
BMI 25 – 29.9
Class I
BMI 30 – 34.9Class II
BMI 35 – 39.9
Class III
BMI 40
45% 4% 6%33% 12
%
* BMI (Body Mass Index): A measurement of an individual’s weight in relation to height (kg/m2).
1:10 of the Australian adult community
BEACH 2003-2004 the Australian adult population data consistent with AUSDIAB data
Potential candidates for surgery
How much weight will I lose?
Slow, gradual weight loss (0.5 kg per week)
60% excess weight loss in 2 years
Requires life-long commitment to change
Requires long-term follow-up
The LAP-BAND® produces similar sustained weight loss as more
invasive surgery
%EWL
Years of Follow Up
O’Brien P, McPhail T, Chaston T, & Dixon J Obes Surg. 2006: 16; 1032-1040.
Weight loss is gradual!
BUT HOW DOES IT WORK?
The LAP-BAND® System Allows You to
Tame Your Hunger!
The LAB-BAND® System acts by allowing small meals to satisfy for a long period – You can choose to eat less without becoming hungry. It “Tames Hunger” providing a tool you can
work with to allow significant weight loss
The LAP-BAND® System Is Affordable
Private health insurance Reimburses cost of LAP-BAND device, theatre staff, time
and equipment to do operation
Reimburses most of hospital stay
There are “out of pocket” specialist fees
Can I take out insurance now? YES
BAND adjustments- $15 “out of pocket” charge per
adjustment
Next Steps If you would like to schedule a consultation to
see if the LAP-BAND® System is appropriate
for you:
– Contact our reception (02) 6584 3268
69 Lake Rd, Port Macquarie 2444
Reception @portlapsurgery.com.au
www.portlapsurgery.com.au