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Surgical treatment of obesity

Surgical treatment of obesity. Size of the problem. DM Sleep apnoea HT Pulmonary failure Depression Arthritis. Heart Disease Stroke Hernias Reflux Stress incontinence Pulmonary embolism. Associated Morbidities. Metabolic Syndrome. HT Insulin resistance Dyslipidaemia

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Surgical treatment of obesity

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  1. Surgical treatment of obesity

  2. Size of the problem

  3. DM Sleep apnoea HT Pulmonary failure Depression Arthritis Heart Disease Stroke Hernias Reflux Stress incontinence Pulmonary embolism Associated Morbidities

  4. Metabolic Syndrome • HT • Insulin resistance • Dyslipidaemia • Cardiovascular disease • (Sleep apnoea)

  5. 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

  6. Morbid obesity in NZ prevalance

  7. Morbid obesity in NZ prevalance • Prevalance related to social deprivation • Quintiles • 5 38% • 4 26% • 3 23% • 2 21% • 1 21%

  8. Obesity and life expectancy

  9. What is the best way to manage severe obesity? Exercise / Drugs

  10. What is the best way to manage severe obesity? Diet

  11. Malabsorptive Restrictive Combination Adjustable Band Gastroplasty Biliopancreatic Diversion w/ Duodenal Switch Roux en Y Gastric Bypass Bariatric Surgery Today

  12. External Referral Internal Referral Meets criteria Yes No Patient completes questionnaire Patient attends Bariatric seminar Return to referrer MDT discussion Patient discharged Patient accepted onto programme Further investigation required Patient declined - return to GP Patient discharged What do we do?

  13. New patients

  14. Discussion • Criteria • Dietetics • Gastroscopy • Weight loss • Psyche • Perioperative management • Politics • Audit • Research

  15. 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!

  16. She did the Marathon

  17. Outcomes of Gastric Bypass • Weight loss • Improvement in illnesses • Change in life expectancy • Quality of life

  18. 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

  19. Improvement in illnesses • Type 2 Diabetes 83.7% • High Blood Pressure 75.4% • High Cholesterol 93.6% • Obstructive Sleep Apnoea 86.6%

  20. 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)

  21. 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

  22. Outcomes -Diabetes

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