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Obesity Resources

A local Website: www.melbourneobesitysurgery.com.au

Article: www.mja.com.au/public/issues/183_06_190905/obr10369_fm.html .. copy

Surgery for Morbid Obesity

THE LAP-BAND: an adjustable silicone gastric band for the treatment of morbid obesity
-Extract from:
The Obesity Surgery Centre, Melbourne.

Obesity is a very common problem in our society. It has been estimated by the National Heart Foundation that 9% of men and 11% of women in Australia are obese. There are various ways of defining the different levels of obesity. The most useful of these is the Body Mass Index.

The Body Mass Index is a measure which combines both the weight and height according to the following formula. BMI= Weight (in Kg)/Height2 (in meters).

The normal body mass index is 20-25, overweight people have a body mass index of 25-30, obese people have a body mass index of 30-40, and morbidly obese people have a body mass index of greater than 40. If the body mass index is greater than 50 some refer to this as super-obese.

If your body mass index is greater than 40 it is likely that you are suffering from major medical, physical or social problems because of your weight. Some will be suffering these problems even at a body mass index values between 35-40; some don't seem to have a major problem even above BMI of 40. However it is around this BMI that we generally start to see the major problems caused by obesity.

If the concept of the body mass index is confusing to you, a rough approximation of a BMI of 40 is to be 80% above your ideal weight or to be 45kgs above your ideal weight.

WHAT ARE THE PROBLEMS OF MORBID OBESITY?

Reduced Life Expectancy
The first problem to stress is the one that most obese people focus on least - you are less likely to live a long life if you are too fat. The life insurance companies have known this for a long time. They know that for life insurance purpose, the fatter you are the worse risk you are to them.
As your weight increases so too does this risk so that by the time you reach a body mass index of 40 the risk is more than twice that of people who have normal weight. The risk can be expected to rise steeply as your weight goes above a body mass index of 40.

Medical Diseases
The next major group of problems caused by morbid obesity is medical diseases. There is a long list of illnesses that are either caused by, or made worse by, obesity. There are too many for you to focus upon so we will shorten it to the more important and frequent problems.

These include diabetes, high blood pressure, asthma, atherosclerosis which leads to heart disease and stroke and often blood vessel diseases, sleep apnoea where you stop breathing during sleep, and wearing out of joints - especially in those areas which have to carry the extra weight such as the lower back, the hips, the knees and ankles. Also obese people are at risk of accidents at work or at home or on the road and of sudden unexplained death.

Physical Limitations
Morbidly obese people often cannot do things that others can do. Sporting activities are generally out, which excludes them from many family activities.

Physical activity of any sort can be quite difficult due to shortness of breath or just plain tiredness, so that even housework or standard employment is a challenge.

Most cannot buy clothes easily and some difficulty getting into and out of cars, into seats on the bus or the theatre.

Flexibility is reduced. The toes get progressively out of reach and personal hygiene can become a problem.

Social Isolation
Not surprisingly most who are morbidly obese feel embarrassed in public. It is common to sense that people are looking at them and commenting on their weight and the difficulties it produces in dressing well and moving easily. They prefer to withdraw - to live within the family circle at home rarely venturing into the public gaze. This may help them to cope with the embarrassment but equally it deprives them of the chance to work, the chance to join the family in outside activities and to join friends socially. It is not too surprising therefore to find that the morbidly obese have a low level of self esteem and a feeling of worthlessness and uselessness and it is common for them to suffer depression. They hate their appearance and feel that they are totally unattractive to their partner and to all others.

SO THAT'S THE PROBLEM…WHAT ABOUT A SOLUTION?

First we might ask why it is that some people become morbidly obese. The answer appears simple -they have eaten more than they have needed. The calorie intake has exceeded the calorie use. No matter how much we might argue about the detail, it is a fundamental truth that if we take more calories than we use up, we will store them and put on weight. Therefore the solution appears simple - obesity can be cured by taking in less calories and/or by increasing the energy used.

This is all very true, it is very simple and it is very hard to achieve. The traditional method for weight reduction always has been and still remains the same - we must take in less energy than we use up and we must use up more energy - diet and exercise. Gastric restriction does not change this process at all, it just makes the process of dieting easier to achieve and then as weight comes down the process of exercise also becomes easier.

In theory we shouldn't need gastric restriction at all - eat less and do more and the weight will come down. Sadly, for most, it just does not happen. Something more is needed and this is where operations for restricting food intake come in.

Gastric Restrictive Operations
All operations on the stomach are designed to reduce weight, whether they be gastric stapling procedures as have been common in the past or the Lap Band procedure, do two things - they limit the amount of food that the stomach will hold at any time, and they slow down the emptying of the small stomach. In this way, if you eat about the amount of food that you can get into half a glass, you will feel comfortably full and because of the slow emptying the feeling of fullness will stay with you for several hours so that you won't have the urge to eat between meals.

As a consequence you are quite comfortable having three small meals each day with no eating between meals. The Lap Band does not enforce this pattern - it simply facilitates good eating practices.

For gastric restrictive operations to work you must establish good eating habits. Take only three regular small meals a day with no snacks in between.

Each meal has to be solid food. The procedure does not work for liquid calories, so all liquids taken have to be of insignificant calorie content - such as water, mineral water, tea, coffee and low calorie soft drinks. As you cannot eat much food the food you eat must be nutritionally good, high in protein and high in complex carbohydrates or fibre. It must include vitamins and minerals.

You cannot waste your eating capacity on empty calorie foods. The main foods to be encouraged are vegetables, meats, bread, egg dishes and such like.

THE LAP-BAND
There are many variations of operations on the stomach to achieve weight loss. The Lap-Band which is an adjustable silicone gastric banding procedure which can be readily performed without need for a large incision is favoured.

It is a less invasive procedure than all other forms of gastric reduction. For most people the band can be placed laparoscopically (key-hole surgery) by passing some tubes through the skin and doing the operation through those tubes. This avoids any large incision in the stomach, it avoids a lot of handling of the gut inside and it avoids much of the pain that goes with an operation. It enables you to get back to your normal activities more rapidly than would occur with other procedures. For various reasons some people will still have to have an open operation, but because the placing of the band doesn't involve as much trauma to the tissues the recovery is still quite rapid.

North East Valley Division General Practice, Victoria, Australia, Disclaimer 
Level 1, Pathology Building, Repatriation Campus, A&RMC, Heidelberg West VIC 3081. .. map
Phone: 03 9496 4333, Fax: 03 9496 4349,  Email: nevdgp@nevdgp.org.au
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