19 February 2019
Q&A with Mr Mike Pellen MD FRCS MBBS
Consultant Upper GI and Bariatric Surgeon at Spire Hull and East Riding Hospital
I can't lose weight or I just regain it when I do – can you help?
Weight loss with or without a procedure requires commitment and lifestyle change to achieve the best results. Although control over the demands of life to make time to plan diet and exercise are fundamentally important, many become frustrated when weight loss stalls or it creeps back on so they give up. Scientific evidence now reveals that this complex process is partly because our bodies become very efficient at holding onto weight we have gained when we try out new diets or engage in short bursts of exercise when motivated.
Losing weight requires a sustained calorie “deficit” (reducing calories in your diet). Although the recommended daily intake for women is less than 2000 calories, weight loss requires a daily reduction by around 600 calories.
Weight loss procedures can achieve calorie restriction through feeling fuller more quickly, a reduction in appetite-stimulating hormones and in some cases reduced absorption of energy from food and drink. Options include both temporary endoscopic balloon procedures and more permanent keyhole surgery operations.
Who are weight loss interventions recommended for?
Some guidance on which weight loss procedures are effective and for whom is provided by the National Institute for Health and Care Excellence (NICE). In general patients are very likely to benefit when their weight starts to reach a certain threshold that cause medical conditions to develop (diabetes, high blood pressure, arthritis and sleep apnoea) which can be potentially reversed in part or in full by these treatments.
There is growing evidence for interventions before this point when “medical obesity” develops. The longer a patient is overweight the more chance there is of developing long-term health problems even if they are yet to be diagnosed. The NHS defines obesity when somebody’s body mass index (BMI) reaches 30 or more. The NHS has an online calculator at https://www.nhs.uk/live-well/healthy-weight/bmi-calculator/ which can be a useful indicator.
When BMI reaches 35, you are carrying around 50% more weight than is healthy for your height. When non-surgical measures like diets, exercise programmes or medications have failed to achieve sustained weight loss it as this point operations become very effective tools in helping individuals regain control of their weight.
I would always recommend meeting with your GP to exclude a medical or psychological contribution to weight gain before moving on to these options.
Which is the best procedure for me?
This a question you should discuss with a weight loss surgeon who provides a range of interventions, not just one, and particularly because different options are better suited to certain individuals’ circumstances, their goals and their weight loss history. A very brief overview is provided below.
The gastric balloon is a temporary (up to one year) fluid filled sphere placed inside the stomach through a 15-minute endoscopic procedure performed under local anaesthetic throat spray or sedation. Balloons delay stomach emptying and reduce the space available for a meal or snacks. Weight loss is around 2-3 stones (approximately 30% excess weight lost). Some patients develop side effects of reflux or nausea, though newer adjustable balloons are now available which can be deflated while they remain in place to reduce these symptoms.
Weight loss operations take between 60-90 minutes and are usually performed using keyhole surgery under a general anaesthetic. They achieve weight loss through “restricting” the amount of food you can eat to a small tea plate (eg gastric band or sleeve gastrectomy), reduce calorie absorption (eg the gastric bypass) and in some cases can reduce appetite for several months.
The gastric band requires the placement of an inflatable ring around the top of the stomach connected to an access port buried under the skin that requires adjustment injections of fluid to achieve the correct sensation of fullness.
The sleeve gastrectomy permanently removes 80% of the stomach turning it into a tube which creates a permanent feeling of fullness with smaller meals without need for any adjustment.
The gastric bypass partitions the stomach (without removal) creating a small pouch connected directly to the small bowel; downstream your surgeon rejoins the small intestine carrying digestive enzymes so that you digest and absorb fewer calories (energy) from your food.
You can expect to lose around half of your excess weight with a gastric band and more than two-thirds of your excess weight with the sleeve gastrectomy and gastric bypass. Most weight loss is achieved within the first year where it stabilises.
How will an operation affect me?
Essential daily vitamin supplements are required long-term to avoid nutrition complications. A dietitian is a vital member of the team caring for you before and after your procedure.
Weight loss surgery can have dramatic improvement in fertility. Contraception is an important consideration even if you are planning to start a family as pregnancy is not recommended within the first 18 months to ensure the baby develops healthily.
How safe is the surgery?
With many years of experience in this surgery, serious complications are now rare and the most recent UK data shows less than 3 in 100 patients have serious complications related to their surgery and the risk to life is less than 1 in 300. It is now safer than many other common operations.
How can I find out more?
To make an appointment to see Mr Michael Pellen, or for further information contact Spire Hull and East Riding Hospital on 01482 672 412.