01 January 2020
I’m sure we’ve all over-indulged this Christmas, I know I have. So during January we tend to start considering healthier lifestyles. With an estimated two thirds of UK adults being either overweight or obese, I caught up with Consultant General Surgeons Mr Michael Lewis and Mr Vivek Chitre to weigh up the options available to Norfolk patients. Words by Helen Harper, Spire Norwich Hospital.
With global warming causing rising sea levels the island we all live on is getting smaller – sadly the same can’t be said of its inhabitants. Obsesity rates are now more than 20% higher than there were in the 1960s*. Why is this? Of course lifestyles have changed in the past 50 years – we use cars much more to get around and there are fewer manual jobs. Farming is ever more mechanised and modern careers often involve sitting at a desk and working on a computer for prolonged periods. Add to this the continued growth of fast food outlets offering relatively inexpensive high calorie food. It is no great surprise that this combination has led to many people eating more calories than they burn – the end result is weight gain.
Mike Lewis, Consultant General Surgeon at Spire Norwich Hospital comments. “Weight loss surgery should not be considered an easy option. We try to discourage those looking for a ‘quick fix’ because they will invariably be disappointed. Patient compliance and ‘buy in’ are critical for good results and those who think a sleeve gastrectomy or gastric band is a ‘magic cure’ often do less well than more motivated patients with realistic expectations. We rightly offer surgery for medical reasons only and patient eligibility is assessed in line with the National Institute of Clinical Excellence (NICE) guidelines”.
Mr Lewis continues, “Norfolk may be considered a healthy rural area to live and work but in recent years the number of weight loss operations being performed in Norwich has been rising steadily year on year. This may be partly due to greater awareness of obesity surgery in both the general population and primary care”.
One way to lose weight is to reduce the amount one eats. There are startling successes from dieting, they appear every week in both women’s and men’s magazines. However, we rarely hear what happens to these dieters in the long run. The British Medical Journal revealed that almost all dieters put weight back on and many end up ‘yo-yo’ dieting. The problem is that if a person feels permanently hungry and there is food available, it is extremely difficult to resist temptation forever.
NICE recognise the vast nature of this problem and recommends surgery for patients with a Body Mass Index (BMI) over 35, providing they have tried other ways of losing weight.
Mr Vivek Chitre, Consultant General Surgeon explains why it’s dangerous to have a BMI greater than 35; “The risks of dying are five or more times greater than somebody of the same age whose BMI is less than 25. The more your BMI climbs above 35, the greater the health risks. Many common conditions are directly related to obesity. These include high blood pressure, diabetes, arthritis, heartburn and reflux, gallstones, cancer, stress incontinence and depression. Life expectancy is also heavily linked to weight”.
Mr Chitre continues “There are several types of operation available with varying degrees of impact in terms of weight loss and life style changes. The most common procedure is the laparoscopic adjustable gastric band. The band is placed through a keyhole (laparoscopic) operation under a general anaesthetic with a stay of 12–24 hours in hospital. A sleeve gastrectomy is a bigger operation with a longer recovery period requiring a one or two night stay in hospital. Finally a laparoscopic gastric bypass is the largest operation and is usually reserved for people with severe health and weight problems. The best results from surgery are obtained if a good follow-up process is in place. It makes sense that your surgeon and the team who care for you are nearby. Overseas travel is not recommended as complications can exist following any surgery and being thousands of miles from your surgeon is never wise”.
So what does success look like? Mr Lewis and Mr Chitre explain; “Success is usually measured by the amount of Excess Weight Loss (EWL). A laparoscopic gastric band will give on average a 50% EWL: our results in Norwich show an EWL of 60% two years after surgery. The weight does not come off immediately after surgery; and the amount lost does vary quite considerably from person to person. Of course, if patients have a laparoscopic gastric band, but neglect their aftercare and band adjustments, weight loss may be disappointing”.
All surgery carries an element of risk and the content of this page is provided for general information only. It should not be treated as a substitute for the professional medical advice of your doctor or other healthcare professional.