Weight Loss Surgery. helping you make the right choice

Transcription

1 Weight Loss Surgery helping you make the right choice

2 Contents What causes obesity? 3 Are you eligible for surgery? 4 suitable candidates for weight loss surgery what is weight loss surgery? body mass index waist measurement The surgical procedures 6 gastric banding (Beacon Hospital) gastric bypass Important information 8 how to access surgery an inclusive package what are the risks of surgery? What happens after surgery? 9 A life changing experience 10 changing the way you eat how will your life change? how much weight will you lose? 1

3 Surgery can provide a weight loss solution for people who have a large amount of weight to lose, and who have been unable to lose weight by other methods. If you have tried everything to lose weight, but can t, then weight loss surgery at Beacon Hospital could be the answer. But it is not a quick fix, or an easy option. This booklet provides information that will help you understand the process, the implications and the risks involved. It should help you prepare for your next step in your weight loss journey. You ll receive care and support from a team of specialists before, during and after surgery. Please note: This brochure is solely a guide to those who may be interested in obesity surgery procedures, and as such all information here is of a general nature. It cannot be a substitute for a consultation with a specialist doctor or surgeon in conjunction with your GP, as individual expectations can vary. The final decision to carry out a procedure is at the consultant s discretion, based on comprehensive assessment by the multidisciplinary team of specialists. 2

4 What causes obesity? Many things can lead to obesity. The five main causes are listed below: 1. Energy balance Your body needs the energy that comes from the food you eat in order to function properly and remain healthy. When you eat the same amount of food that your body needs, your weight stays the same. If you get more energy from your food than you need, some is left over. Your body stores that extra energy as fatty tissue. If your body never uses the extra fat, you will gain weight. 2. Hereditary If others in your family are obese, then you have a higher risk for obesity. 3. Metabolic disorders Changes in metabolism, or how your body gets energy from food, may affect your energy balance and your weight. For example, an underactive thyroid gland may result in weight gain. 4. Eating and social habits Eating an unbalanced diet, snacking between meals and not getting enough exercise, may all contribute to obesity. 5. Psychological factors Social or emotional eating is also one of the main causes of gaining weight. Any one or a combination of these factors can lead to obesity. As science continues to search for answers, obese individuals must understand how to treat their condition in the most effective way. Part of your initial assessment would be to confirm your suitability for treatment. Using the chart on page 5 will help you to decide whether you require surgery or non surgical treatment. Not everyone who has a weight problem should consider surgery your own particular Body Mass Index (BMI) will determine whether you are overweight, obese or morbidly obese. Eating an unbalanced diet, snacking between meals and not getting enough exercise may all contribute to obesity. 3

5 Are you eligible for surgery? There are two main ways of establishing if you may be eligible for surgery. The first uses your height and weight to calculate your Body Mass Index (BMI), and the second simply uses your waist measurement... Suitable candidates for obesity surgery An ideal BMI is 19 to 25. If your BMI is between 25 and 30, you are thought to be overweight. If it is higher than 30, you are obese. That means you are at risk of health problems. Your BMI is the best indicator and if your BMI is 35 or more, surgery might be a suitable approach. For people with a BMI between 35 and 40 who have conditions associated with obesity, for instance sleep apnoea, diabetes mellitus, or heart problems, your doctor might suggest surgery to help you lose weight. Patients whose BMI s fall between 30-35, who do not qualify for surgical intervention, may be suitable for weight management programmes. Please discuss this option with your GP. 4

6 What is weight loss surgery? Weight loss surgery reduces the amount of food you can eat by reducing the size of your stomach or bypassing it. There are two main types of operation, gastric banding and gastric bypass. Your consultant surgeon will discuss the options with you and decide which would suit you and your lifestyle. The surgery practiced at Beacon Hospital is the former, gastric banding, which is the less invasive form. It s important to remember that surgery is only part of the solution. You will need to meet certain criteria in order to be eligible for surgery. You will also need to change what you eat and increase your exercise levels following surgery. But don t worry, you will have a team of people here at Beacon Hospital to help you. Body Mass Index Your BMI is a measure of body fat based on height Weight (kgs) and weight. It is calculated by taking your weight in kilograms divided by your height in metres squared. The chart below calculates your BMI for you. You may be eligible for surgery if your BMI is over 40, or if it is over 35 and you have other medical conditions. Waist measurement Excess weight, as measured by BMI, is not the only risk to your health. The location of stored fat can also indicate an increased risk. Carrying fat mainly around your waist suggests you are more likely to develop health problems than if you carry the weight on your hips and thighs. A very simple indication that you may be eligible for surgery is your waist measurement. 6' 4" Men with a waist measurement of over 40 inches 6' 3" and women with a waist measurement of over 6' 2" 35 inches may be eligible for weight 6' 1" loss surgery. 6' 0" 5' 11" Height (ft/in) 6' 4" 6' 3" 6' 2" 6' 1" 6' 0" 5' 11" 5' 10" 5' 9" 5' 8" 5' 7" 5' 6" 5' 5" 5' 4" 5' 3" 5' 2" 5' 1" 5' 0" 4' 11" 4' 10" ' 10" ' 9" ' 8" ' 7" OK overweight ' 6" ' 5" ' 4" ' 3" ' 2" OK overweight obese ' 1" ' 0" ' 11" BMI ' 10" potential candidate for surgery stone 11 stone 12 stone 13 stone *There are 14 pounds (lbs) in a stone Height (ft/in) Height (m) 10 stone 11 stone 12 stone 13 stone 14 stone 16 stone 17 stone 18 stone 19 stone 20 stone Weight (lbs)* 5

7 The surgical procedures There are two main types of weight loss surgery. These are gastric banding and gastric bypass. Gastric banding, which is carried out in Beacon Hospital, is suitable for most patients with a BMI between 35 and 55. Gastric Banding Gastric banding, sometimes known as lap banding is a highly effective procedure to help overweight people achieve substantial and longterm weight loss. The operation limits how much food you can eat. An inflatable band is placed around the stomach to divide it into two parts. This creates a smaller pouch at the top, which takes less food to make you feel full. The food then passes slowly through the opening left by the band and into the lower part of your stomach and continues on as normal. The band can be inflated by injecting fluid to reduce the size of the opening into the lower part of the stomach. This will restrict the amount of food you can eat even further and make you feel fuller for longer. The band is inserted laparoscopically, through four or five small incisions. This is sometimes referred to as keyhole surgery. Adjustments to the band are made by injecting fluid through a very small tube which has a special button-like reservoir just under your skin. It can be inflated and deflated in this way, until the right level of restriction is established. This may take several visits to the hospital over a period of several months following surgery. Gastric Banding Summary of information: Usually for patients with a Body Mass Index (BMI) of under 55 Hospital stay of one (or at most two) nights Recovery time approximately 2 weeks A reversible procedure Repeated visits to hospital required to adjust band Average weight loss 55% of excess weight 1 band around stomach (inflatable) small stomach pouch reservoir stomach 6

8 Gastric Bypass A gastric bypass is also a highly effective procedure. It helps very overweight patients to achieve substantial and permanent weight loss. It does this by restricting the amount you can eat, and by reducing the amount of calories absorbed from the food that you do eat. The operation creates a small stomach pouch in the same way as the gastric band. But instead of the food passing into the stomach through the band, it bypasses the stomach and much of the intestine through a section of the small intestine that has been re-routed and grafted onto the stomach. The procedure can be carried out laparoscopically (by keyhole surgery) through five or six small incisions. It can also be carried out as an open operation with one vertical incision in the abdomen. Which operation is right for you? Your surgeon will discuss all the options with you and establish which operation is most suitable for you and your individual needs. The tables below show some key points for each type of operation. Please note that currently Beacon Hospital offers gastric banding only. Gastric Bypass Summary of information: Results in greater, more permanent weight loss Major surgery with greater risks of complications Hospital stay of three to six nights Recovery time approximately six weeks Not easily reversible Lifelong nutrient supplement required Average weight loss 70% of excess weight 2 small intestine bypassed small intestine gastric pouch staples bypassed portion of stomach 7

9 Important information How to access surgery gastric banding in Beacon Hospital Please visit your GP, who will, if appropriate, refer you to the programme in Beacon Hospital. In the hospital your consultant will talk through the procedures with you in detail, perform a detailed medical assessment and decide the best route for you. They will also take you through the detailed aftercare programme in place to take care of you following surgery. An inclusive package To give you peace of mind, we offer a fixed price package so that you know exactly how much your operation will cost, before you have surgery. This includes all initial consultations, surgery, followup consultation and support from our team of experts. There are no hidden extras. The initial assessment is free of charge, so you don t need to pay anything if you decide not to go ahead with surgery. What are the risks of surgery? Most people get through their operation with few problems. But, as with any surgery, there are risks of serious complications such as heart attack or blood clots. Though it is very rare, there is a risk of not surviving the operation. More common complications include wound and chest infections. It is important that you understand the risks fully before you agree to proceed with an operation. Your consultant will make sure you have all the information you need to help you make your decision. 8

10 What happens after surgery? After surgery After gastric banding, you will stay in hospital for one night. Your consultant will visit you during this time, and you will be looked after by a team of professional nursing staff, on-hand whenever you need them. Recovery time Weight loss surgery is a major operation, so it is important that you take time to recover. You are likely to feel tired and need rest when you get home. You may need someone at home to help you, and you will need to take time off work. You can expect to be back to normal within two weeks of surgery for a gastric band. But everybody is different, and your consultant and specialist team will help you decide when you are ready to return to your normal activities. Your diet following surgery Immediately following surgery you may not be able to digest food properly. So you will be put on a diet of liquid food to start with. You will then need to eat soft or puréed food for a few weeks before you can move onto solid food. Your dietician will give you guidance on how to increase your intake gradually as eating solid food before you are ready could result in pain or vomiting. Weight loss surgery can help to improve your health and general well being. 9

11 A life changing experience Please remember that best results will only come about with a partnership approach between you and the medical team here at Beacon Hospital. We will provide the surgery and all the advice you will need and you will need to take our dietary advice and exercise as appropriate. Changing the way you eat Weight loss surgery works by reducing the amount of food you can eat. You will no longer be able to eat in the same way that you do now. Portion sizes will be much smaller and you will need to eat each meal slowly, sitting at the table in an upright position. You will need to chew much more thoroughly and restrict your fluid intake during meals. There may be some foods that you are not able to eat in the long term. These include white bread, boiled rice, pasta, meat chops, steak, nuts and fibrous fruits and vegetables such as oranges, pineapples, green beans and mushrooms. Eating too much, choosing the wrong type or texture of food, or eating too quickly could cause vomiting. (If you have had a gastric bypass you will need to take a chewable or dissolvable multi-vitamin every day for the rest of your life, to make sure you are receiving all the essential nutrients you need). If you regularly organise meals for other family members, you may not be able to eat the same sort of food as them. Whilst they may eat their meal on a dinner plate, your portion will be small enough to fit on a tea plate. If you go out to dinner, your meal will be equivalent to a starter size rather than a main meal. And if you have takeaways, you will find these portion sizes are far too large, and you may not be able to eat the type of food available. You will have regular one to one meetings with your dietician who will help you through any problems you are having and manage your diet with you. Your dietician will give you ongoing personal support to help you manage your diet following surgery. 10

12 How will your life change? The result of weight loss surgery should help to improve your general wellbeing. You should be able to undertake more physical activity and many patients find their self-confidence increases. Patients are often more inclined to socialise and spend more time out with their friends and family. Your general health should improve with the weight loss and increased activity. You will be less at risk of obesity related diseases such as heart disease, high blood pressure, cancer and diabetes. If you already suffer from these complaints, then the pattern of their disease should slow down or stop completely after time. How much weight will you lose? The partnership between the gastric band on one hand, and your healthy eating choices and activity levels on the other, is very important in order to maximise your weight loss after surgery. Everybody is different, so it is difficult to predict exactly how much weight you would lose. Weight loss is also dependent on your weight before surgery, your food choices and the amount of exercise that you do. On average people who undergo a gastric banding operation lose around half of their excess weight within two years of surgery. Your dietician will give you ongoing personal support to help you manage your diet following surgery. 11

13 Weight loss surgery can help to improve your health and general well being. References: 1. BMJ Obesity surgery, Gastric Banding, Jan Colquitt J, Clegg A, Sidhu M, Royle P. Surgery for morbid obesity. Oxford: The Cochrane library No. 3

14 Consultant profile Consultant name: Qualifications: Mr Robert C Stuart MB ChB BAO FRCSI MCh FRCS (Gen) FHKCS FRCPS (Glas) Background information: Qualified University College Dublin 1982 Senior Lecturer & Consultant Surgeon, Glasgow Royal Infirmary Major clinical interests and subspecialty: Specific bariatric surgery training: General surgery, upper gastrointestinal surgery, laparoscopic surgery, therapeutic endoscopy Clinical expertise in surgery and endoscopy for benign and malignant diseases of the upper gastrointestinal tract with 15 years experience in open and laparoscopic weight loss surgery and is currently an EAES trainer in advanced laparoscopic and bariatric surgery Introduced laparoscopic gastric stapling and bypass to Scotland Specific clinical interests include laparoscopic surgery for morbid obesity, laparoscopic antireflux surgery, laparoscopic surgery for achalasia and therapeutic endoscopy Research interests include bariatric surgery, Barrett s oesophagus and the role of inflammation in oesophageal cancer Advanced gastrointestinal laparoscopic fellowship with Prof SCS Chung, Hong Kong Open bariatric surgery with Prof J Baxter (Treasurer of BOSS) Glasgow Laparoscopic gastric bypass and banding with Mr Simon Dexter and Prof McMahon, Leeds 2000 Professional memberships: Member of BOSS, AUGIS and EAES Registered on the Specialist Register Other relevant information: obesitysurgery@mac.com

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