Obesity

Morbid obesity is a different entity to just being overweight. It is by no means understood yet. It appears to be a complex problem whereby there is a failure in the mechanism that keeps us fairly even in weight, despite wildly fluctuating calorie intake, and calories burnt. This is due to a combination of genetic problems, endocrine problems, fat metabolism problems, and problems with messages between the stomach, appetite centres, sleep/wake centres, and foraging centres.

The result is an increase in fat that gets deposited in and around vital organs, the consequences of which can lead to premature death, and associated disorders. Hence the term "Morbid Obesity" does not describe the size of a person, but rather that the weight has become such a problem it is causing morbidity.

In most of these patients, there seems to be over-stimulation of the appetite centres causing a primitive instinctive drive to eat, and just like other survival instincts such as breathing, there is no will power in the world that can override this drive for very long. That's why diets will only work for a short time, and will not work for long in these patients. Just like diabetics cannot metabolise sugar very well, the morbidly obese cannot metabolise fats efficiently.

Because life expectancy is shortened, and general health suffers, not to mention an awful quality of life, surgery is offered to those in whom all else fails. In the majority of cases, the illnesses associated with morbid obesity improve or disappear as the weight loss occurs. Diabetics are frequently off all medication, as are hypertensives and refluxers. 70% of patients treated for depression are able to come off medication. The health benefits are enormous. Countless studies reported in the medical literature prove the benefits of surgery. A recent study by the Melbourne group now demonstrates that surgery is superior to long term medically supervised weight loss.

There are several operations for weight loss. We perform 2 of them, both laparoscopically. Both have advantages.

Neither separates the stomach from the brain!

Gastric band entails placing an inflatable cuff around the upper stomach, and this is attached to a small reservoir hidden under the skin of the abdominal wall. This reservoir can easily be accessed with a small needle, which allows inflation or deflation of the band i.e. it is adjustable. So if you get pregnant, we deflate the band enough so that the baby is not compromised, then reinflate after delivery! The advantages are it is removable, adjustable, and doesn't alter the normal route that food takes down the gastrointestinal tract. It works by restricting the volume of food, and suppresses appetite. If someone is not hungry, it is easier to say “No thanks”.

Gastric bypass also restricts the volume of food able to be eaten. It has the added advantage that it bypasses a length of intestine so the food won't be absorbed. Most patients find that if they eat the wrong food (high calorie), they get very uncomfortable so it also has a punitive effect for those who get tempted! (“Dumping syndrome” – who comes up with these terms?!)

There are many incorrect claims about each procedure. Both procedures always work….unfortunately the brain sometimes needs prompting.

There is no clear indication as to which operation to use. Gastric banding has a lower mortality and complication rate. The weight loss appears to be faster after bypass, but the ASERNIP study in Australia showed that the final amount of weight loss is equal for both procedures. Thus the decision is made after thorough consultation. Either can be converted to the other procedure.

Life style changes are essential. Close follow-up is also essential.

People's size is genetically determined, so we are unable to define the desirable amount of weight loss. Our definition of success is 2 fold:-

1. A BMI below 35

2. A size where the patient is happy and comfortable.

To find out more about Obesity and our services, visit our Obesity Surgery website www.nzobesitysurgery.co.nz