Transcript No Slide Title

Fight obesity with effective and
guaranteed tools
Haitham Al-Khayat, MD
Consultant general and bariatric
surgeon
New Dar Al-Shifa hospital
t
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 2nd most common cause of death
from a modifiable behavioral risk factor
Obesity related comorbidity
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Type II DM
Hypertension
Cardiac diseases
Strokes
Hyperlipidemia
Respiratory
diseases
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Degenerative
osteorthritis
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Depression
GERD
Nephrotic
syndrome
Infertility
Venous stasis
ulcers
Pseudotumor
cerebri
Causes of obesity
Behavior
Genetics
Environment
Environment portion size
Nonoperative treatment
how does it add up??
Nonoperative treatment
how does it add up??
Diet
Exercise
Behavioral therapy
+ Drug therapy
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Why Surgery?
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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
Surgery is effective
Pre-operative Medications
Post-operative Medications
Surgical treatment of obesity
Indication of surgical options
Patient selection
BMI ≥ 40 kg/m2
OR
BMI 35 - 40 kg/m2 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
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Restrictive
Reversible
40-55% EBW
loss
Lap sleeve gastrectomy
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Restrictive
Very popular in
Kuwait
60-70% EBW
loss
Relatively new
with unknown
long term
consequences
Roux En Y gastric bypass
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First done in
1967
60-70% EBW 14
year followup
Results of bariatric surgery
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Weight loss
Resolution or improvement in
comorbidity
Increased longevity
Improved QOL
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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
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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 2nd 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;293:1861-1919
Excess U.S. Medical Costs Related
to Abnormal Body Weight
Int J Obesity 2005;29:334-339
Relative risk of health problems
associated with obesity
Greatly increased
(relative risk >>3)
Moderately increased
(relative risk 2-3)
Diabetes
Coronary heart disease
Gall bladder disease
Osteoarthritis (knees)
Hypertension
Hyperuricemia and
gout
Dyslipidemia
Insulin resistance
Slightly increased
(relative risk 1-2)
Cancer (breast cancer in
postmenopausal women,
endometrial cancer, colon
cancer)
Reproductive hormone
abnormalities
Breathlessness
Polycystic ovary
syndrome
Sleep apnea
Impaired fertility
Low back pain
Increased anesthetic risk
Fetal defects arising
from maternal obesity
The Effect of Obesity on the Development
of Health Risks
Age-adjusted relative risk of type 2 diabetes
50
100
Men1
42
40
93
Women2
75
30
50
40
20
12
25
10
2.2
8.1
1.0
0
<23
25
31
35
0
1.0
<22
25
31
35
BMI
1Chan
JM et al. Diabetes Care 1994;17:961-969; 2Colditz G et al. Ann Intern Med 1995;122:481-486.
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.