Patient Info

The top 6 things to know about weight loss surgery

1. It is the most effective treatment for Obesity and it’s related illnesses (ref 1)
  1. Losing significant weight (more than 50% of one’s excess weight) is extremely difficult due to the body’s defense mechanisms. Many studies of non-surgical weight loss programs, diets, extreme exercise routines show >95% failure after 2 years with eventual weight regain and sometimes beyond that original weight. (ref 2)
    Surgery has been shown to be >90% successful in getting significant weight off (minimum of 50% excess body weight up to 100% EBW loss) after 2 years.

 

2.  Surgery can reverse many of the serious medical effects of obesity such as diabetes, hypertension, sleep apnoea and many other conditions
  1. Diabetes – The Australian Diabetic Council recommends surgery as the only effective treatment of T2 diabetes when associated with obesity (ref3). Studies have shown excellent levels of resolution and reversal of diabetes following WL/ Bariatric surgery (ref4) (ref5)
  2. Sleep Apnoea – one of the most significant health complications of obesity is Sleep Apnoea (OSA) which results in poor quality sleep, daytime tiredness and fatigue and even more seriously the long term implications of oxygen deprivation whilst asleep such as heart disease and dementia.(ref 6)
  3. Hypertension – High blood pressure leads to heart disease, kidney failure and strokes amongst other conditions. Hypertension is most commonly associated with being overweight and obese and most patients after bariatric surgery have a marked reduction in hypertension with many patients discontinuing their BP medications
  4. Depression – Issues relating to poor self-esteem, social withdrawal can be substantially improved once patients lose significant weight. Often patients treated with anti-depressant medications notice weight gain which is an unwanted side effect their medication. Bariatric surgery can help overcome this problem.
  5. Chronic knee and back pain – Many patients suffer chronic pain from their back and knees as a result of carrying that extra weight. Often this manifests in the later years of life and can be one of the most debilitating aspects of health in the 5th and 6th decades of life, sometimes earlier. Many patients after successful bariatric surgery can avoid having knee or hip replacements later in life.

 

3. Eligibility is based on age and BMI.
  1. Patients who have attempted to lose weight through conservative measures for a period of > 2years
    And fit the BMI criteria (see below) should be considered for bariatric surgery
  2. Age guidelines vary but in general patients under the age of 70 are considered for surgery if they fulfill the BMI criteria. Whilst not common, there is increasing evidence for the role of obesity (bariatric) surgery in adolescents/teenagers. (ref 7)
  3. Bariatric surgery is recommended for
    i.   Patients with BMI > 40
    ii.  Patients with BMI > 35 with medical conditions such as diabetes, OSA, HT, Arthritis etc
    iii. Patients with BMI > 32 with medical conditions (as above)and are of Asian, Indian or Indigenous heritage
  4. BMI (Body Mass Index) is a way to predict what a patient’s weight should be for a given height. Calculation = Weight in kg /Height in metres2.
  5. According to guidelines ideal BMI 20-25, overweight 26-30, Obese >30, Morbidly obese > 40, Super obese > 50 (Note BMI is not accurate in athletes or body builders who have a disproportionately high level of muscle mass)
  6. For example If your height is 1.7m your weight should be (assuming BMI 24 is ideal) 24 x 1.7 x 1.7 = 69.36 kg

 

4. Surgery is not a quick fix. It is not the easy way out as you need to continue to ‘’work at it”
  1. In general surgery is an indication for anyone who fulfills the above criteria of age, BMI and failed previous attempts at losing weight
  2. Patients who have better long-term results see surgery as a way to break the cycle of obesity BUT also realizing that they need to maintain healthy eating habits for the future to prevent the weight coming back again.
  3. Surgery combined with a healthy diet, regular exercise and a positive mental approach is the key to success
  4. Many patients will attest to the fact that surgery is not easy.
    i.   It involves a preparation diet to shrink the liver e.g. Optifast
    ii.  Some patients have nausea and tiredness for a few weeks post-operatively
    iii. After bariatric surgery eating is not the same again. The first 6 weeks immediately afterward require a very specific diet of soups, blended and pureed foods. Portion sizes are dramatically reduced which can impact social situations. Certain foods are more difficult to eat e.g. bread and red meat for the first few months
    iv. Drinking water at the same time as eating is often difficult and may result in regurgitation
    v.  Some patients find that success may be resented by others, including family members, and say things like “he/she took the easy way out” and make disparaging remarks, thereby showing a lack of understanding. Some family members won’t want you to have surgery as they fear the complications of surgery. The reality is simply that surgery risks are very low 1% or less versus the adverse effects of ongoing obesity such as a reduction in life expectancy, developing diabetes, heart disease, cancer, sleep apnoea, joint damage etc etc.
    Not to mention the massive psychological impact of constantly being obese and being treated differently by family, friends and work colleagues.

 

5. What types of operations are available for weight loss and which is best for me?
  1. There are many different types of operations, procedures and devices available for weight loss in Australia. It is through a general understanding of the options (as described here) and a discussion with your doctor and/or specialist where hopefully an informed decision can be made by the patient.
  2. The most common operation for weight loss by far in Australia is Laparoscopic Sleeve Gastrectomy (LSG). It is also referred to as Laparoscopic Gastric Sleeve or Vertical Sleeve Gastrectomy. Recent data from Medicare Australia reveal that more than 12,000 Sleeve Gastrectomies were performed in Australia in 2015. The incidence and frequency of these cases is also rising particularly in the last 5 years. Patients have a very high satisfaction of weight loss within a short period of time.
  3. There are 2 other operations for weight loss also seen in Australia, the Gastric Band and Gastric Bypass.
    i.   Gastric Banding – there have been over 150 000 cases performed worldwide but interestingly the gastric band has reduced in popularity with patient complaints of frequent vomiting and inconsistent weight loss. There were 2500 gastric bands placed in Australia in 2015 with the most in Victoria.
    ii.  Gastric Bypass - although the Gastric Bypass has been the most frequent operation for obesity worldwide, this has not been the case in Australia due to the technical difficulties and challenges presented to surgeons. More recently with surgical improvements it is gaining popularity and now available. There are now 2 forms of gastric bypass – the Roux en Y (considered the standard) and the Omega Loop (also known as the “Mini’’ bypass) There is healthy debate as to which form of bypass is the better for patients. The gastric bypass has the highest weight loss statistically with excellent outcomes particularly for diabetics. However the side-effects are not insignificant and must be considered. There were 1600 gastric bypasses performed for weight loss in Australia in 2015. 5 years ago there were less than 300 performed in Australia showing it’s increase.
  4. There are other operations/procedures for weight loss that are not as commonplace but may suit a particular patient’s individual circumstance. These are
    i.   BPD (Bilo-pancreatic Diversion) and DS (Duodenal Switch). Due to the surgical complexity and operative risk patients may end up with severe complications. There were only 37 cases in total performed in Australia in 2015.
    ii.  Gastric plication – this involves folding the stomach on itself to reduce capacity. There are concerns about durability of effect and complications. Not considered mainstream.
    iii. Gastric balloon and the Endo-Barrier – Both endoscopic day procedures for weight loss with the benefit of the patient not requiring general anesthesia. These procedures are somewhat controversial as they have short-lived results and have complications that can be severe. There is no item number for the intra-gastric balloon so data is not freely available as to the actual number being performed in Australia which is of some concern.

 

6. How are these operations actually performed?
  1. Most (if not nearly all) operations for weight loss surgery in Australia are now performed laparoscopically (Key-hole), unless there is a specific surgical reason in which case it may be performed “open” (through a large cut)
  2. These specific reasons may be
    i.   Previous Bariatric surgery – eg previous stomach stapling, gastric band
    ii.  Previous Gastric surgery, including anti-reflux surgery such as Nissen Fundoplication, hiatal hernia surgery
    iii. Previous major abdominal surgery performed via open approach – eg bowel surgery, liver, spleen surgery (Note previous gallbladder surgery does not generally affect bariatric surgery) where adhesions may be severe
    iv.  Intra-operative bleeding that cannot be controlled laparoscopically
    v.  In the specific situation of previous gastric band surgery where the patient may be considering converting to a gastric sleeve or gastric bypass this can be performed laparoscopically in most cases. The conversion operation can be performed either in 1 or 2 stages depending on the surgeons preference as well as the condition of the stomach and abdominal cavity at the time of surgery.

 

REFERENCES
  1. Clinical guidelines management of overweight and obese – Australian Government Department Health and Aging 2013. “hierarchy of effectiveness of treatment in adults” – page 124
  2. O’Brien et al 2006
  3. Zimmet
  4. Buchwald et al 2009
  5. Rubino et al 2016
  6. Surgery. 2007 Mar;141(3):354-8. Epub 2006 Dec 8.
    Objective evidence that bariatric surgery improves obesity-related obstructive sleep apnea.
    Haines KL1, Nelson LG, Gonzalez R, Torrella T, Martin T, Kandil A, Dragotti R, Anderson WM, Gallagher SF, Murr MM.
  7. Ref re Bariatric surgery in Adolescents
  8. Australian Government, Department of Human Services

About Us

Combining a team approach to treatment and providing dietary and nutritional advice as well as personalised lifestyle training will result in the best results from weight-loss surgery.

Westmead

Westmead Private Hospital

Suite 9, Specialist Centre

16-18 Mons Road

Westmead NSW 2145

Phone: +61 2 9687 7019

Fax: +61 2 9687 7138

Email: info@sydneybariatricclinic.com

Campbelltown

VUE Building

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1 Centennial Drive, Park Central

Campbelltown NSW 2560

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Norwest

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17-19 Solent Circuit

Norwest, NSW 2153

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Penrith

Cosmetic Culture

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(Enter via 17 Higgins Street)

Penrith NSW 2750

Phone: +61 2 9687 7019

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