what is obesity?
Excessive body fat •A chronic disease with serious health problems and life-threatening consequences •Risk factor for at least 30 common health conditions with huge demand on health resources •Leads to significant medical, psychological, social, physical and economic impacts
normal = 18.5-24.9/ overweight = 25-29.9/. obese = 30-34.9/ severe obese = 35-39.9/ morbidly obese = over 40
risk of obesity?
With BMI > 30 –55% increase in mortality –70% increase in coronary artery disease –75% increase in stroke –400% increased risk of type II diabetes •Obesity can shorten life expectancy by 7 to 15yrs. •A morbidly obese adult has a 33% chance of living to age 65 compared to a person of normal weight (BMI < 25)
Diabetes •Hypertension •Lipid disorders •Heart disease •Sleep apnoea •Gallstones •Acid reflux •Osteoarthritis •Low back pain •Depression •Cancer (breast, colorectal, prostate, endometrial.)
psychological impact of obesity?
Depression •Low self-esteem •Social isolation •Lack intimacy •Decreased libido
Dieting (eg. Weightwatchers, slimming world) •Exercises (eg. Gym) •Medical therapy •Cognitive Behavioural Therapy •Gastric balloons •Weight loss (bariatric) Surgery
Orlistat (Xenical) reduces fat absorption –Dose dependent –Side-effects may include oily bowel motion and stomach upset. •Sibutramine (Reductil) - appetite suppressant. –Reduces food intake by a quarter. •Continued treatment results in weight loss of 711lbs
Roux en Y gastric bypass •Gastric band insertion •Sleeve gastrectomy All procedures are performed laparoscopically
lap roux en Y gastric bypass?
Reduced gastric capacity –Eat fewer meals & reduced snacking Malabsorption –25% of small bowel bypassed
down side of lap roux en Y?
Perioperative mortality (1%) & morbidity (10-15%) •Need for open surgical incision <5% •Prolonged recovery •Requirement for long term multivitamins and mineral supplementation •Potential nutrient deficiencies
long term complications?
laproscopic gastric band insertion?
Restrictive procedure with production of 30 mls pouch •Eat fewer & smaller meals •No loss of GIT continuity •Reversible
a well adjusted band ?
Good weight loss –Approximately 1.5-2.0 pounds per week •Able to eat most solid foods –Exceptions thick breads and thick meats –Must thoroughly chew food and eat slowly –Comfortably eat a small selected solid meal •No limitations of liquids –Except during meals –Never recommend high calorie liquids
Laparoscopic •85% of stomach removed (not reversible) •Reduces the capacity to eat •May be especially suitable for patients with BMI > 60 •Can be option for patients in whom surgery is particularly high risk. cutting the stomach in half risks: 0.5% mortality •Gastric leak 5% •DVT 0.5% •PE 0.5% Removal of spleen 1% benefits: Weight loss of 70 – 120 lbs over 18 months to 2 years •However outcome is less predictable than Roux-en-Y bypass •Long term results remain to be established
effects of bariatric surgery?
1035 morbidly obese patients undergoing RYGB vs. 5746 obese age & sex matched controls •Followed < 5 years •89% reduction in mortality after RYGB •0.68% mortality rate vs. 6.1% in controls