surgical treatment of obesity. size of the problem
TRANSCRIPT
![Page 1: Surgical treatment of obesity. Size of the problem](https://reader031.vdocuments.site/reader031/viewer/2022032703/56649d195503460f949ee4e1/html5/thumbnails/1.jpg)
Surgical treatment of obesity
![Page 2: Surgical treatment of obesity. Size of the problem](https://reader031.vdocuments.site/reader031/viewer/2022032703/56649d195503460f949ee4e1/html5/thumbnails/2.jpg)
Size of the problem
![Page 3: Surgical treatment of obesity. Size of the problem](https://reader031.vdocuments.site/reader031/viewer/2022032703/56649d195503460f949ee4e1/html5/thumbnails/3.jpg)
Associated Morbidities
• DM• Sleep apnoea• HT• Pulmonary failure
– Depression
• Arthritis
• Heart Disease• Stroke• Hernias• Reflux• Stress incontinence• Pulmonary
embolism
![Page 4: Surgical treatment of obesity. Size of the problem](https://reader031.vdocuments.site/reader031/viewer/2022032703/56649d195503460f949ee4e1/html5/thumbnails/4.jpg)
Metabolic Syndrome
• HT
• Insulin resistance
• Dyslipidaemia
• Cardiovascular disease
• (Sleep apnoea)
![Page 5: Surgical treatment of obesity. Size of the problem](https://reader031.vdocuments.site/reader031/viewer/2022032703/56649d195503460f949ee4e1/html5/thumbnails/5.jpg)
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
![Page 6: Surgical treatment of obesity. Size of the problem](https://reader031.vdocuments.site/reader031/viewer/2022032703/56649d195503460f949ee4e1/html5/thumbnails/6.jpg)
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%
![Page 7: Surgical treatment of obesity. Size of the problem](https://reader031.vdocuments.site/reader031/viewer/2022032703/56649d195503460f949ee4e1/html5/thumbnails/7.jpg)
Morbid obesity in NZ prevalance
• Prevalance related to social deprivation
• Quintiles– 5 38%– 4 26%– 3 23%– 2 21%– 1 21%
![Page 8: Surgical treatment of obesity. Size of the problem](https://reader031.vdocuments.site/reader031/viewer/2022032703/56649d195503460f949ee4e1/html5/thumbnails/8.jpg)
Obesity and life expectancy
![Page 9: Surgical treatment of obesity. Size of the problem](https://reader031.vdocuments.site/reader031/viewer/2022032703/56649d195503460f949ee4e1/html5/thumbnails/9.jpg)
What is the best way to manage severe obesity? Exercise / Drugs
![Page 10: Surgical treatment of obesity. Size of the problem](https://reader031.vdocuments.site/reader031/viewer/2022032703/56649d195503460f949ee4e1/html5/thumbnails/10.jpg)
What is the best way to manage severe obesity? Diet
![Page 11: Surgical treatment of obesity. Size of the problem](https://reader031.vdocuments.site/reader031/viewer/2022032703/56649d195503460f949ee4e1/html5/thumbnails/11.jpg)
Bariatric Surgery Today
Adjustable Band Gastroplasty
Restrictive
Roux en Y Gastric Bypass
Combination
Biliopancreatic Diversion w/ Duodenal Switch
Malabsorptive
![Page 12: Surgical treatment of obesity. Size of the problem](https://reader031.vdocuments.site/reader031/viewer/2022032703/56649d195503460f949ee4e1/html5/thumbnails/12.jpg)
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
![Page 13: Surgical treatment of obesity. Size of the problem](https://reader031.vdocuments.site/reader031/viewer/2022032703/56649d195503460f949ee4e1/html5/thumbnails/13.jpg)
New patients
![Page 14: Surgical treatment of obesity. Size of the problem](https://reader031.vdocuments.site/reader031/viewer/2022032703/56649d195503460f949ee4e1/html5/thumbnails/14.jpg)
![Page 15: Surgical treatment of obesity. Size of the problem](https://reader031.vdocuments.site/reader031/viewer/2022032703/56649d195503460f949ee4e1/html5/thumbnails/15.jpg)
Discussion• Criteria• Dietetics• Gastroscopy• Weight loss• Psyche• Perioperative management• Politics• Audit• Research
![Page 16: Surgical treatment of obesity. Size of the problem](https://reader031.vdocuments.site/reader031/viewer/2022032703/56649d195503460f949ee4e1/html5/thumbnails/16.jpg)
![Page 17: Surgical treatment of obesity. Size of the problem](https://reader031.vdocuments.site/reader031/viewer/2022032703/56649d195503460f949ee4e1/html5/thumbnails/17.jpg)
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!
![Page 18: Surgical treatment of obesity. Size of the problem](https://reader031.vdocuments.site/reader031/viewer/2022032703/56649d195503460f949ee4e1/html5/thumbnails/18.jpg)
She did the Marathon
![Page 19: Surgical treatment of obesity. Size of the problem](https://reader031.vdocuments.site/reader031/viewer/2022032703/56649d195503460f949ee4e1/html5/thumbnails/19.jpg)
Outcomes of Gastric Bypass
– Weight loss– Improvement in illnesses– Change in life expectancy– Quality of life
![Page 20: Surgical treatment of obesity. Size of the problem](https://reader031.vdocuments.site/reader031/viewer/2022032703/56649d195503460f949ee4e1/html5/thumbnails/20.jpg)
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
![Page 21: Surgical treatment of obesity. Size of the problem](https://reader031.vdocuments.site/reader031/viewer/2022032703/56649d195503460f949ee4e1/html5/thumbnails/21.jpg)
Improvement in illnesses
• Type 2 Diabetes 83.7%
• High Blood Pressure 75.4%
• High Cholesterol 93.6%
• Obstructive Sleep Apnoea 86.6%
![Page 22: Surgical treatment of obesity. Size of the problem](https://reader031.vdocuments.site/reader031/viewer/2022032703/56649d195503460f949ee4e1/html5/thumbnails/22.jpg)
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)
![Page 23: Surgical treatment of obesity. Size of the problem](https://reader031.vdocuments.site/reader031/viewer/2022032703/56649d195503460f949ee4e1/html5/thumbnails/23.jpg)
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
![Page 24: Surgical treatment of obesity. Size of the problem](https://reader031.vdocuments.site/reader031/viewer/2022032703/56649d195503460f949ee4e1/html5/thumbnails/24.jpg)
Outcomes -Diabetes