Fight obesity with effective and guaranteed tools t Haitham Al-Khayat, MD Consultant general and bariatric surgeon New Dar Al-Shifa hospital

Obesity Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems. Obesity is the 2 nd most common cause of death from a modifiable behavioral risk factor

Obesity related comorbidity Type II DM Hypertension Cardiac diseases Strokes Hyperlipidemia Respiratory diseases Degenerative osteorthritis Depression GERD Nephrotic syndrome Infertility Venous stasis ulcers Pseudotumor cerebri

Causes of obesity Genetics Behavior Environment

Environment portion size

Nonoperative treatment how does it add up?? Diet Exercise Behavioral therapy + Drug therapy. ??????

Why Surgery? Diet and exercise are not effective long term in the morbidly obese Surgery is an accepted and effective approach Surgical risk is acceptable vs. risk of long-term obesity

Surgery is effective

Pre-operative Medications Post-operative Medications Surgery is effective

Surgical treatment of obesity Indication of surgical options

Patient selection BMI ≥ 40 kg/m 2 OR BMI kg/m 2 with significant comorbidity High risk health problems Ineffective documented dietary attempt

The Gastrointestinal system

Operative approaches Restrictive Procedures Adjustable silastic gastric banding (ASGB) Sleeve gastrectomy Gastric plication Combined Procedures Roux-en-Y gastric bypass ( GBP )

Lap Band Restrictive Reversible 40-55% EBW loss

Lap sleeve gastrectomy Restrictive Very popular in Kuwait 60-70% EBW loss Relatively new with unknown long term consequences

Roux En Y gastric bypass First done in % EBW 14 year followup

Results of bariatric surgery Weight loss Resolution or improvement in comorbidity Increased longevity Improved QOL  Health  Social  Personal  Work

General Complications of Weight-Loss Surgery Post-operative depression Food issues Changes in relationships Hair loss Usually temporary Cause: protein, vitamin A, mineral Excess skin

Weight loss program team Surgeon Nurse practitioner Dietitian Anesthesiologist Nurses Cardiologist SAFETY and RESULTS

Final words * Surgery is only a tool * Patients must commit to lifelong changes in diet and behavior * Think seriously about options * We are here to help

Defining the Problem

The Problem Prevalence of obesity in U.S. increased from 12% to 21% between 1991 and 2001 = 15 million people Obesity is the 2 nd most common cause of death from a modifiable behavioral risk factor 111,909 excess deaths annually Mokdad AH et al. JAMA. 2003;289:76-79 Flegal KM et al. JAMA 2005;293:

Excess U.S. Medical Costs Related to Abnormal Body Weight Int J Obesity 2005;29:

Diabetes Gall bladder disease Hypertension Dyslipidemia Insulin resistance Breathlessness Sleep apnea Greatly increased (relative risk >>3) Coronary heart disease Osteoarthritis (knees) Hyperuricemia and gout Cancer (breast cancer in postmenopausal women, endometrial cancer, colon cancer) Reproductive hormone abnormalities Polycystic ovary syndrome Impaired fertility Low back pain Increased anesthetic risk Fetal defects arising from maternal obesity Moderately increased (relative risk 2-3) Slightly increased (relative risk 1-2) Relative risk of health problems associated with obesity

1 Chan JM et al. Diabetes Care 1994;17: ; 2 Colditz G et al. Ann Intern Med 1995;122: Age-adjusted relative risk of type 2 diabetes The Effect of Obesity on the Development of Health Risks <  35 <  35 Men 1 Women 2 BMI

Fed up with how her diet is going Charlene takes a more serious aim at her target weight

Weight Maintenance after Bariatric Surgery Sjöström L, Lindroos AK, Peltonen M et al. N Engl J Med. 2004;351:26

Conclusions Bariatric surgery is an effective means to achieve clinically significant, permanent weight loss with low rates of complications. Bariatric surgery results in significant improvement in health risks associated with obesity. Surgical weight loss increases life-span. Surgical therapy is cost-effective.