Obesity or weight loss treatment
What is obesity?
Obesity as a medical diagnosis is defined as Body Mass index (BMI) greater than 30. However, this rounded number is quite a crude measure of excess or problematic weight. Excess weight and excess body fat deposition puts people at risk of several chronic health conditions. Obesity has negative effects on our daily lives and is associated with lower life expectancy.
How common is obesity in New South Wales?
In Australia two thirds (67%) of adults are overweight and the rates of obesity are rising.
In 1995, 1 in 5 people being clinically obese, in 2017-2018 this had risen to over 1 in 3 people in 2017-8.
Over this period our lifestyles and the food we eat has changed dramatically. Food companies are more commonly marketing unhealthy food choices and our busy lives and sedentary working conditions have contributed to this change.
Understanding weight gain
Obesity results from a sustained energy imbalance - when energy intake from eating and drinking is greater than energy expended through physical activity. This energy imbalance might be influenced by a person’s biological and genetic characteristics, and by lifestyle factors.
The amount of energy you need to survive varies from person to person and depends on your age, body size, physical activity and whether you are pregnant. The body is highly efficient at storing excess energy from foods into fat, to be used later. This fat is stored in the liver and fatty tissue underneath the skin and in the abdominal cavity.
Energy is expended in three ways:
- Basal metabolic activity – this is the amount of energy used to maintain the body (keep your heart beating, lungs moving, brain working etc) and we often refer to this as metabolism. Some people may have higher metabolism than others.
- Thermic effect of food – this is the amount of energy used to break down, digest and absorb food for the body to use. Fast (processed) foods have a lower thermic effect and are often higher calorie.
- Physical activity – This is the amount of energy to move around and includes normal day to day activity, in addition to exercise. Our daily jobs play a large part in our energy expenditure with outdoor manual workers burning 40% more energy than sedentary workers.
Why do people become overweight or obese?
People have become more overweight due to the lifestyle and food changes in society over the last 20 years. Changing diet has played the largest role, with many modern processed foods being high in fats, carbohydrate and sugar.
One of the main issues we have with food is that we can’t 'give up food' like we can give up smoking or alcohol. We need to eat to maintain ourselves and this is often why dieting alone is difficult and unsutainable. Eating is also a large part of all our social lives, and it may be considered rude to turn down food or leave it on your plate.
What are the health impacts of obesity?
Obesity is associated with several health problems and importantly is associated with a reduced life expectancy. Excess weight, especially obesity, is a major risk factor for cardiovascular disease, type 2 diabetes, some musculoskeletal conditions and some cancers.
As the level of excess weight increases, so does the risk of developing these conditions. In addition, being overweight can hamper the ability to control or manage chronic conditions.
How obesity affect me?
A large number of the patients we treat have battled with their weight for many years. Successful weight loss has been achieved for periods of time with dieting often followed by weight regain. Many people have tried restrictive diets and gym memberships yielding short terms results, only to regain weight in the months after.
Many people have given up trying to lose weight and become distressed and have low mood or anxiety about their weight. Many of our patients tell us they are sick of being the "fat guy" or "the big girl". Excess weight also leads to social stigmatisation, and this can extend to the workplace, leading to reduced career progression.
We understand that some of the triggers for seeking obesity surgery are often not medical, they are often emotional. Day to day activities may cause distress, such as:
- shopping for clothes or needing to shop at speciality clothes stores
- anxiety about travelling on a plane or public transport
- catching up with their kids, taking them to the beach
- the feeling of people watching you eat in a café or restaurant
- feeling self-conscious about going to a gym or exercise class
Low mood, low self-esteem, anxiety and depression of some of the most common symptoms of obesity.
What are benefits of losing weight?
In addition to the health benefits, the magnitude of weight loss achieved with surgery can be lifechanging. These may seem like small things being able to buy clothes from a ‘normal shop’, travel on a bus or plane, having a bath, playing with your kids or even tying your shoelaces.
Why is it so difficult to lose weight and sustain weight loss by conventional means?
Only a small fraction of people are able to lose large amounts of weight conventionally and keep it off. This is not failure, we are biologically and psychologically programmed to eat when food is available and plentiful. Our bodies are also highly efficient at storing energy. Dieting or fasting makes the body more efficient at storing energy and triggers strong hunger cravings, as the body goes into famine mode.
Exercise may be difficult to perform for if you are overweight, the most common reasons why this is difficult is due to back or joint pains or the stigmatisation of being overweight. Weight loss from exercise can also stimulate hunger.
How is obesity measured?
Overweight and obesity can be measured in several ways, including the commonly used Body Mass Index (BMI). BMI is an internationally recognised measure of overweight and obesity at a population level for both adults and children.
However, BMI it is only a guide and not the only consideration. Factors which affect BMI as a measure of excess body fat include gender, muscle mass and body fat distribution.
BMI alone does not adequately assess the risk of obesity related disease and complications.
Body mass index (BMI)
The following standard cut-off points are used for adults (age 20 and over):
|
BMI |
|
|
20-25 |
Normal |
|
25-30 |
Overweight |
|
30-35 |
Obese |
|
35-40 |
Severely Obese |
|
40-50 |
Morbidly Obese |
|
50+ |
Super Obese |
Waist Circumference
While not an indication for weight loss surgery, waist circumference is an alternative way to assess risk of developing obesity-related chronic diseases. A higher waist measurement is associated with an increased risk of chronic disease. The risk levels presented below are for Caucasian men, and both Caucasian and Asian women.
|
Increased risk |
substantially increased risk |
|
|
Men |
94cm |
102cm |
|
Women |
80cm |
88cm |
Am I a candidate for surgery?
Weight Loss Surgery may be considered if you are:
- Unable to achieve a healthy body weight for a sustained period, even though supervised dieting and exercise.
- Have a BMI over 40.
- Have a BMI over 35 and are experiencing negative health effects.
- Weigh more than 45 kg above your ideal body weight.
- Highly motivated and committed to long term lifestyle changes.
The team at the Bodyfree clinic will look at BMI (Body Mass Index) and in addition also consider the patient’s overall health and any existing medical diagnoses.
What are the surgical options for weight loss?
Endoscopic bariatric procedures
Recently introduced endoscopic procedures have been developed to assist in weight loss. These procedures include the gastric balloon, gastric vent (aspire assist) and endoscopic stomach suturing. These procedures are not as durable as the surgical weight loss options and result in less weight loss and lower rates of remission of chronic disease. They are often branded as non surgical procedures, but can be more difficult for patients to tolerate and can still be associated with complications.
Laparoscopic adjustable gastric band
Gastric banding used to be the most common procedure for weight loss in Australia, before the advent of advanced techniques laparoscopic sleeve gastrectomy and laparoscopic gastric bypass. Gastric banding is a safe and reversible procedure, but many patients experience side effects and the Laparoscopic adjustable gastric band is now rarely performed.
Laparoscopic Sleeve Gastrectomy
Laparoscopic sleeve gastrectomy is a safe and durable procedure for most people seeking obesity surgery. Severe complications are rare and on average patients lose 60-70% % of their excess weight by two years. The laparoscopic sleeve gastrectomy results in less long-term nutritional problems when compared to gastric bypass. This procedure is not reversible, as part of the stomach is removed from the body. In addition to making the stomach smaller, it is believed removing the upper/outer portion reduces the production of some hormones reducing hunger cravings.
Laparoscopic Gastric bypass
This group of procedures involve making the stomach smaller and combining this with rerouting food, so it doesn’t pass through part of the small bowel (where food is absorbed). It therefore reduces the size of the stomach (restrictive effect) and the usable length of the small bowel (absorptive effect). Studies have shown the highest proportion of weight loss and remission of diabetes with these procedures. However, they are more complicated and requires a strong commitment to long term follow-up, blood tests and nutritional supplements. The rate of complications is also slightly higher than seen with sleeve gastrectomy. Gastric bypass may be performed as a Roux-en-Y or single anastomosis (mini) bypass.
Revision bariatric surgery
Revision Bariatric Surgery can be performed for patients who have undergone a previous Bariatric procedure, most commonly Gastric Banding and sometimes Gastric Sleeve.
The reasons for considering Revision Surgery may be due to lack of weight loss, weight regain, significant reflux symptoms or other problems. The exact reasons why these problems occur are quite complex. The decision of what is best for the patient will likely require some investigative procedures to be conducted to look at the stomach prior to deciding on a surgical plan, of course the goal outcome will also direct the decision.
How is weight loss surgery performed?
Bariatric surgery is performed in hospitals with specialised equipment to perform the procedure. Surgery in nearly all cases can be completed by keyhole surgery (laparoscopic). After the procedure people can walk around assisted and drink water after around 4 hours.
How long will I be in hospital?
People are generally required to stay in hospital for 1-2 nights for sleeve gastrectomy and 1-2 nights for gastric bypass.
Will I need to be on special diet after surgery?
After surgery a specialised diet is undertaken for 6 weeks. This diet aids initial weight loss and allows the staple or suture lines on the stomach heal. Adherence to this diet is one of the most important aspects to the success of surgery. During these 6 weeks you will see and be in consultation with your dietician.
It is important to keep well hydrated after surgery; you will need to drink small amounts of fluid regularly to keep hydrated. During each day you will need to consume over 1.5L of fluid.
As a general guide the 6-week diet includes
|
First two weeks |
Protein rich fluids |
|
Week two to four |
Pureed foods |
|
Week 4 to six |
Soft/mushy diet. |
High calorific foods, high sugar foods, processed foods, alcohol and soft drinks must be avoided.
How much does Bariatric surgery cost?
At the BodyFree weight loss clinic the 2-year weight loss program associated with bariatric surgery has a single ‘out of pocket’ payment of $3990 for both primary sleeve gastrectomy and gastric bypass. Revision Bariatric surgery has a higher set fee due to the complex nature of the surgery.
Do I have to have regular follow ups after surgery?
Yes, it is important to be monitored during your weight loss journey. Your dietician and weight loss surgeon will help you navigate the pitfalls of weight loss after surgery. Appointments are not a ‘weigh in’ but to ensure you remain healthy and in charge of your journey.
If I want more information, what should I do?
The best source of information may be friends, family members who have had experience with weight loss surgery. Of the people who have had experience with surgery, many will have also tried multiple diets, meal replacements and tablets without success. Your general practitioner may also be able to advise you and can provide you with a referral for a discussion with the team at BodyFree.
For more information about Bariatric Surgery, visit the BodyFree Weight Loss Clinic.