July 2015 Issue No.17 DON T LET OBESITY SPOIL YOUR HEALTH AND YOUR LIFE www.sghgroup.com JEDDAH RIYADH MEDINA ASEER HAIL SANAA DUBAI CAIRO
Definitions Over View and General Facts General Key facts! Worldwide obesity has more than doubled since 1980. In 2014, more than 1.9 billion adults, 18 years and older, were overweight. Of these over 600 million were obese. 39% of adults aged 18 years and over were overweight in 2014, and 13% were obese. Most of the world s populations live in countries where overweight and obesity kills more people than underweight. Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health. Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. It is defined as a person s weight in kilograms divided by the square of his height in meters (kg/m2). According to WHO, obesity can be classified depending on BMI as the following BMI Classifications Below 18.5 Underweight 18.5-25 Normal 25-30 Over Weight 30-35 Obesity Class 1 35-40 Obesity Class 2 More than 40 Morbid Obisity 42 million children under the age of 5 were overweight or obese in 2013. Obesity is preventable and manageable Overall, about 13% of the world s adult population (11% of men and 15% of women) was obese in 2014. It isn t just a cosmetic concern, but also it increases your risk of diseases and health problems such as heart disease, osteoarthritis, diabetes, hypertension and cancer. 2
SGH-Dubai Medical Team Leaders Dr. Issam Hreirati Specialist General Surgery, Laparoscopic - Bariatric Surge University Diploma in Laparoscopic Surgery - Lille / France All what you need to know about Obesity Surgery Dr. Mustafa El Hakam Specialist Gastroenterology / Hematology and Endoscopy. Master Gastroenterology, ULB, Brussels All what you need to know about Endoscopic Intragastric Balloon Saudi German Hospital 3
Information on Intragastric Balloon provided BY Dr. Mustafa EL Hakam A-How it works? The saline-filled balloon occupies about one-third of the stomach cavity. This decreases the quantity of food that the stomach can hold. The presence of the balloon also interferes with stomach emptying, such that food stays in the stomach longer. Together, these effects promote diminished appetite and early satiety with lesser food quantities. gastric varices, etc. - Not currently pregnant and no intention of becoming pregnant in the next 12 months following BIB placement - No addiction to alcohol or drugs - No previous bariatric surgery, intestinal obstruction, or adhesive peritonitis - No history of chronic or current use of high doses of NSAID and or aspirin C-Technique The balloon system is inserted in the stomach during a simple endoscopic procedure done under sedation, lasting between 10-15min. During this time, the stomach is examined for any abnormalities and then the balloon is inflated with 550-600cc of saline mixed with methylene blue. D-Before the procedure No special preparations are done for the balloon insertion. All it needs is to come to the endoscopy unit fasting 8hrs. B-Who is a candidate for Balloon insertion? - Subjects between the age of 18-60. - Subjects with a 30 < BMI < 34.9 who have significant health risks related to their obesity or failed in maintaining weight loss with non-surgical weight loss methods. - Subjects with a < 35 BMI < 38 - Subjects with BMI > 38 with contraindication to surgical procedure - No congenital or acquired anomalies of the GI tract, such as large hiatal hernia, atresias or stenosis, esophageal and or 4 4
E- After the procedure 1- Side effects: It is very likely that the presence of the balloon in the stomach will cause nausea, vomiting or abdominal pain, of varying intensity, for a 3-7 days after placement. Your physician will prescribe medication to help minimize these potential effects, but these can persist during the first week and sometimes needs Intravenous injection to subside. 2- Activities: During the first week of the procedure you should not plan any heavy activities. Once your body has adjusted to the balloon you can continue your normal activities. Starting a regular exercise program is highly recommended and will improve your success. 3- Food Intake For the first 3 days after insertion, you will begin a liquid-only diet, slowly progressing to a semi-solid diet. Within one to two weeks, you ll be able to resume eating normal textured foods. After the 2 weeks, You will not feel like eating as much as you used to. In addition, if you eat fatty foods or sweets, you may feel unwell. Excessive overeating while the gastric balloon is in place can prove dangerous. Alcohol in small amounts is fine. Alcohol consumption raises the risk of ulceration. 4-Follow up visits to the Dr./dietician: The follow-up program is critical to success of the balloon and in learning new lifestyle skills. You will meet with your Doctor several times over the course of the year. It is most important to meet with your dietician/ nutrition counselor at least twice-a-month while the gastric balloon is in place. Patients who follow up weekly have greater success! During this time your progress will be evaluated and you will learn valuable principles of health, nutrition and exercise that will provide you a foundation for longterm success. 5- Spontaneous deflation: Your doctor will place a blue liquid inside the balloon so that if the balloon leaks, the blue liquid will come out and turn your urine green. Should this happen, your doctor should be notified immediately and schedule prompt removal of the balloon. F-Outcome: It is important for you to understand that the Intragastric balloon is a tool to aid weight loss and must be used in conjunction with diet, exercise and a behavior modification program. The amount of weight you lose and maintain will depend on how closely you follow your diet and adopt long-term lifestyle changes. Average weight losses of 16 kg over 6 months and 25 kg over 1 year periods have been reported with gastric balloon. G-Balloon Removal The gastric balloon is removed in the same way it was placed, via the esophagus and mouth using endoscopy under sedation. The balloon can be deflated using the inflation tubing or via puncture using a needle catheter. Saudi German Hospital 5
Information about Surgical management Of Obesity by Dr. Issam Hreirati Why Surgery to Treat Obesity? Many studies have shown that the conventional management of obesity (diet, exercise and modification of lifestyle) has a very high failure rate that may reach 95% of cases, particularly when the excess weight is 35 kg and more. Accordingly, morbidly obese patients have a very little hope to permanently get rid of their excess weight by conservative measures. Knowing that morbid obesity is a health problem and a certain risk factor of many serious conditions (like diabetes, hypertension, atherosclerosis, fatty liver, joint diseases, spine problems, some cancers etc.), an effective and safe solution is very necessary and required to manage morbidly obese patients who failed to treat their obesity by conservative measures. Here comes the role of surgery as an effective, relatively safe and permanent solution Do All Obese People Need Surgery? All whose BMI is equal or above 40 is considered as candidates for surgical management of obesity. People of BMI equal or above 35 is also considered candidates for surgery if they have co-morbidities (disease) that can be attributed to their obesity (like diabetes, joint and spine problems, sleep apnea etc.) Is Surgery for Obesity Safe? The answer is yes. Surgeries for morbid obesity are considered as safe ; complication rate differ from procedure to procedure. Generally speaking, the complication rate is not more than 1-2%. Is Obesity Surgery Effective? The answer is again yes. It is expected that Bariatric Surgery can cause 50-70% excess weight loss. This result will depend on the type of surgery, and the behavior of the patient after surgery. Excellent results will be achieved in highly complying patients who are committed to post- operative instructions and follow-up. In conclusion, to achieve good results, all the following should be considered: - Good indication - Good selection of the procedure - Patient should be well informed and educated about the surgery concept, commitments and follow-ups. - Patient should be highly committed to the post-operative instructions. - Thorough follow-up. 6
Surgical Procedures to Treat Morbid Obesity Many surgeries are suggested and designed to treat morbid obesity. For example, Gastric Band, Gastric Plication, Sleeve Gastrostomy, Gastric Bypass, Mini Gastric Bypass, Biliopancreatic diversion etc. To make things simple, all the procedures could be classified in two categories: A. Restrictive surgeries that will control the volume of the meal, and B. Malabsorptive surgeries that will induce some changes in the consequence of the GI Tract leading to a malabsorptive situation. Each of the previous procedures has its advantages and disadvantages. Practically speaking, the most common procedures worldwide are: 1. Sleeve Gastrostomy 2. Roux-en-y Gastric Bypass We in Saudi German Hospital are capable of doing all types of obesity surgeries although we are concentrating on Sleeve Gastrostomy as the procedure of choice due to its less complication rate and the good results that could be achieved. What About After Surgery? A. Candidate of surgery should believe that operation is the first step (and not the last) on the right track to losing weight. Dealing with the surgery is as important as the quality of the surgery itself. In general, there will be no tough diet to be followed after the surgery; rather, there are some principles and guidelines to be followed as: 1. Avoid high energy liquids (juices containing sugars, sweetened hot drinks, alcohol etc.) 2. Avoid gaseous drinks 3. Avoid over-eating (to eat after feeling full). Following the surgery, patients stay for 15 days on liquid diet, and for another 15 days soft food This is very essential to guarantee uneventful recovery and give enough chance for the division lines to heal well. After 4 weeks, patient can restore back his / her normal diet. Saudi German Hospital 7
Obesity Plan in Saudi German Hospital, Dubai 1. Get benefit of our offer of Free Consultation (contact the main reception for appointments for free obesity consultation) to meet one of our Obesity Team Members who will help you to start putting a proper management plan 2. During this free consultation, a simple and thorough evaluation will be done by an expert nurse and then you will meet one of the Obesity Team Members (usually an expert Bariatric Surgeon) who will explain the treatment options that are suitable for you and will answer your questions and queries. 3. A second appointment may be arranged to meet the specialized professional when needed, this could be a Dietician when conservative measures will be followed, or a GI Doctor when intragastric balloon is considered. This appointment could be at the same day or in a different day according to the availability. 4. The specialized doctor will explain in details the chosen procedure, alternatives and all information. 5. When surgical management is the option, pre-operative preparation is started by booking appointment for Upper GI Endoscopy and some blood tests. Surgery then will be scheduled accordingly. 8 8