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