There's nothing new about obesity – but its rapid rise in the last 25 years is without precedent. Over that period, obesity rates have almost quadrupled and it now causes over 9,000 deaths every year in Britain alone. In fact, two-thirds of UK adults are either obese or overweight and are running many health risks of obesity – and even an early end to their lives.
Health Matters talks to Mr Rob Stuart, Consultant General Surgeon specialising in general surgery and weight loss surgery about the problem - and more importantly - some solutions.
Mr Stuart, just what are the actual health risks of obesity?
Being overweight or indeed obese is not a natural state for the body and it can put pressure on its healthy working in all sorts of ways. You run a greater risk of contracting diabetes, heart disease, a stroke, osteoarthritis, high blood pressure, gallstones – and the associated conditions that those complaints can cause. If you also fail to exercise, obesity contributes to one third of cancers of the colon, breast, kidney and stomach.
So obesity is causing people to die early?
It is. Indeed statistics tell us that being obese can take up to nine years off your normal lifespan, and of course, reduce the quality of your life significantly.
Is being overweight or obese a simple case of eating too much?
It's not as simple as that. A labourer on a building site may need 4,000-5,000 calories a day simply to stay the same weight, but if you drive to work, spend your day at a desk and don't bother to exercise, you may only truly need 1,500-2,000 calories. Anything extra is then stored by your body as fat. So the way you live your life is a major factor.
How do we know if we're at risk from obesity?
The most precise way is to calculate your BMI – your Body Mass Index. You take your weight in kilograms; and take your height in metres. You then divide the first figure by the second figure.
If your score is between 20 and 25, you're probably the right weight. If you're scoring between 25 and 30, you're probably overweight. If you're scoring over 30, this is what we term as 'obese'.
How does weight loss surgery work?
There are four main kinds of procedure, designed either to reduce the amount of food you eat by reducing the size of your stomach, or bypassing the stomach altogether. Each has its pros and cons, according to your particular needs and medical condition.
Can you summarise each for us?
The first is gastric banding. An inflatable band is placed around the stomach to divide it into two parts. This creates a smaller 'pouch' at the top of your stomach, which takes less food to make you feel full. The food then passes slowly into the lower part of the stomach and continues as usual. Gastric banding is flexible, so we can alter the restriction caused by the band and indeed take it away altogether.
What is sleeve gastrectomy?
In this procedure, we permanently remove part of the stomach, reducing its size by about 75%. This obviously means that the patient can only eat small meals and weight loss will follow. Unlike gastric banding, sleeve gastrectomy is not reversible.
What is gastric bypass?
As the name suggests, in this procedure your food is made to by-pass your stomach. Instead it passes through a small intestine that has been re-routed and grafted onto the stomach. This restricts the amount you can eat and reduces the amount of calories absorbed from the food.
Lastly, what is intragastric balloon?
This isn't actually a surgical procedure and only takes about 20 minutes. A special kind of soft silicone balloon, deflated, is passed down the gullet and into the stomach. The balloon is then filled with a sterile fluid, which gives the patient the sense of feeling fuller. Patients follow a supervised aftercare programme with the dietician for 6 months, after which the balloon is removed.
How do you assess which option suits a patient best?
Well the first step is to see whether a patient is suitable for surgery, through an initial assessment with a weight loss clinical specialist. If surgery is considered appropriate, a consultant surgeon will then talk to them about their options. There are many things to consider; not just the procedure itself but also after-care and the commitment the patient will need to make for a successful outcome.
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