LONDON OBESITY CENTRE - FAQ's
What is obesity?
How is obesity treated?
What are the risks of being overweight?
Am I suitable for obesity surgery?
What is Intragastric Balloon?
What is involved in Laparoscopic gastric banding?
What is gastric stimulator?
What is involved in gastric bypass surgery?
What about vertical band gastroplasty?
What about pancreaticobiliary bypass (BPD)?
What is Duodenal switch operation?
Which operation is the right one for me?
How much weight will I loose?
What are the risks and complications of surgery?
Will obesity surgery improve my health?
Do I need to eat a special diet after surgery?
Does surgery alone help weight reduction or do I have to stick to diet and exercises?
Do I need to have plastic surgery after losing weight?
Obesity is an abnormal accumulation of body fat in proportion to body size. Body mass index (BMI) is calculated by dividing the body weight (in kilograms) by height (in metres) squared. Generally BMI does correlate with percentage of body fat, but this relationship is independently influenced by sex, age, & race. Asian populations, however, are known to be at increased risk for diabetes & hypertension at lower BMI ranges than non-Asian groups. You are at increased risk for coronary artery disease, diabetes, and hypertension if you (man) have a waist circumference greater than 40 inches (102 cm) or if your (woman) circumference exceeds 35 inches (88 cm). Thus, an overweight person with abnormal fat pattern may be at high risk for these diseases even if that person is not obese by BMI criteria. ^TOP^
Underweight:<18 Healthy Weight:18 -25 Overweight: 25 -30
Obese: >30 Morbidly Obese: >40 Super Obese: >50
The initial evaluation of overweight and obese patients begins with the exclusion of secondary causes of weight gain and the identification of comorbid disorders such as hypertension, diabetes, heart disease, respiratory problems and sleep apnoea. Once screening is completed, the approach to the treatment of overweight and obesity is similar to that of other chronic diseases: begin with lifestyle improvements including dieting & exercise and then consider medical and surgical options. ^TOP^
What are the risks of being overweight?
Being overweight is associated with a variety of medical conditions including high blood pressure, cardiovascular disease, diabetes, high blood cholesterol and other lipids, an increased risk of developing certain cancers, sleep apnoea, gastro-oesophageal reflux and arthritis etc. ^TOP^
Am I suitable for obesity surgery?
You have to first meet the following criteria (in accordance with NICE guidelines) to be suitable for weight reduction surgery and then you have to balance the benefits with risks of surgery.
1. A BMI greater than 40 or a BMI greater than 35 with asscoicated co-morbidities such as diabetes, sleep apnoea, high blood pressure etc.
2. Age greater than 18.
3. To have adequately tried all appropriate and available nonsurgical measures of weight reduction such as dieting or drug therapy and have failed to maintain weight loss before considering surgery.
4. Should be fit for an operation.
5. Must understand the need for long-term follow up.
6. Do not have any serious psychological problems or alcohol abuse.
^TOP^
A balloon is inserted into the stomach via an endoscope and inflated to ½ - 1 litre of fluid. This gives the feeling of fullness and helps to reduce the intake of food. For a week after the procedure one can be very sick and therefore may have to be hospitalised during that period and given fluids by the vein. You may lose some weight but this is a temporary measure lasting for about 6 months. ^TOP^
What is involved in Laparoscopic gastric banding?
Gastric banding involves placing a band around the upper stomach; this band has a balloon inside leading to a narrow tube connected to a reservoir placed under the skin. The operation is performed laparoscopically (keyhole surgery) and takes only about 40 minutes. You will be allowed home at between 12 and 72 hours after surgery. You start with fluids on the same day which is continued for another 4 weeks. You then start on soft diet and then gradually build up to solid food over the next couple of weeks. About 6 weeks after the procedure, the balloon in the band is inflated using a special needle placed through the skin into the reservoir. This will tighten the band. The amount of fluid in the balloon will need to be adjusted over subsequent weeks to produce the required weight loss. ^TOP^
Gastric stimulator is applying 2 electrodes on to the stomach wall laparoscopically and connected to a stimulator kept under the skin. This will make one feel full and helps to lose excess weight to the order of 30 – 50%. ^TOP^
What is involved in gastric bypass surgery?
The operation is performed laparoscopically and takes approximately 2 hours. The upper part of the stomach is divided and joined onto the small bowel so that the main reservoir of the stomach and some part of small bowel are bypassed. The hospital stay is 3 to 5 days. Fluid is started on the first postoperative day and built up to full diet by six weeks. ^TOP^
What about vertical band gastroplasty?
This operation acts in a similar way to the gastric band but produces a restriction that is fixed and cannot be adjusted in the same way as the gastric band. It has the same complications of bypass surgery without the benefit of MalabsorptionGastric banding is performed instead of gastroplasty by most surgeons. ^TOP^
What about pancreaticobiliary bypass (BPD)?
This is purely Malabsorption operation without the restrictive component. This operation is similar to the gastric bypass but involves bypassing a much greater part of the small bowel and removing distal stomach leading to a significant degree of malabsorbtion. Whilst it can be a very effective way of loosing weight it is also associated with a number of potentially serious complications. It is usually reserved for the super – super obese. ^TOP^
What is Duodenal switch operation?
BPD is now modified and includes 2 parts – Restrictive and Malabsorption. 1st part is Sleeve Gastrectomy taking out ¾ of stomach and the 2nd part is the duodenal switch i.e. the distal bypass. These 2 parts can be staggered so that one can have Sleeve Gastrectomy first and then duodenal switch 6 – 18 months later, reducing the risks operation considerably. ^TOP^
Which operation is the right one for me?
For patients with a BMI less than 40 - 45 gastric banding or Sleeve Gastrectomy is the treatment of choice. For patients with a BMI greater than 40 - 45, diabetes or gastro-oesophageal reflux, gastric bypass surgery is the treatment of choice. For those with BMI of more than 55, Duodenal switch with sleeve gastrectomy may be the right one: Performing Sleeve Gastrectomy first is less risky and make them fit for the next stage of the operation a few months later in these high risk patients. However, these guidelines are not fixed and selection of the type of surgery should be made after discussion with your surgeon. ^TOP^
It depends upon the type of operation you had and how compliant one is with the diet and exercises. Studies suggest that you will loose between 30 and 74 percent of your excess weight, the most rapid period of weight loss being in the first 18 to 24 months following surgery. There is a tendency to regain weight over time and so it is important to develop and maintain good eating habits. However, studies have demonstrated that patients undergoing gastric bypass maintain a weight loss of 50 to 70% of excess weight at between 5 and 6 yrs and one study demonstrated a maintained loss of 50% at 14 yrs. Studies suggest that gastric bypass surgery and BPD/Duodenal Switch are the most effective surgical treatment in maintaining long term weight loss. With gastric banding one may lose about 50% of excess weight over 3 – 5 years. ^TOP^
What are the risks and complications of surgery?
All surgical procedures are associated with some risk. In deciding whether to undergo weight reduction surgery it is necessary to balance the risks of the procedure against the risks of obesity. Complications that can occur following surgery include wound and chest infections, bleeding, injuries to the stomach and bowel and leaks from join in the bowel. It has generally been supposed that surgery on overweight patients is associated with increased risk of complications. Laparoscopic banding is associated with least peri-operative complications. ^TOP^
Will obesity surgery improve
my health?
Weight reduction surgery has been reported to improve several comorbid conditions including diabetes mellitus, sleep apnoea and obesity associated hypoventilation (resulting in hypoxia resulting in sleepiness during the day time even), high blood pressure and serum lipid abnormalities (high cholesterol and triglycerides). ^TOP^
Do I need to eat a special diet after surgery?
You will need to eat a normal balanced diet after surgery. The operation will help in weight reduction but it is important to develop healthy eating habits and eating small portions. Sweets, ice cream and sugar rich drinks must be avoided since they contain a large number of calories, which will cause weight gain. Patients undergoing bypass surgery will need to take vitamins, iron and calcium supplements lifelong and increase the protein intake.
Can I have children after weight reduction surgery?
You should not become pregnant during the period of rapid weight reduction but there is no reason not to after your weight loss has stabilized which is usually about 18 - 24 months after the operation. ^TOP^
Does surgery alone help weight reduction or do I have to stick to diet and exercises?
Weight reduction surgery is a partnership between patient, the patient’s family, surgeon, dietician and other healthcare individuals. In order to loose weight and keep it off it is necessary not just to have the operation but also to eat a balanced diet and to exercise regularly. Many overweight patients find exercising difficult, either because they are embarrassed to go out, or because have arthritic joints or they find their ability to exercise is simply limited by their size. Even so exercise is an important part of losing weight & keeping it off. ^TOP^
Do I need to have plastic surgery after losing weight?
You may or may not. The skin is elastic and tries to mould to your body contour. Sometimes the excess skin may have to be removed – tummy tuck, thigh tuck etc.
www.bospa.org.uk | www.wlsinfo.org.uk | www.nih.gov | www.duodenalswitch.com | www.myobesitysurgeon.com | www.nice.org.uk www.aso.org.uk
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