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Updated 30 May 2013

Obesity surgery a lifeline for some

If you have a Body Mass Index of more than 40 and have tried repeatedly and without success to achieve weight loss, you could be a candidate for gastric bypass surgery. Here's what you need to know.

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"Obesity has reached epidemic proportions, adversely impacting the lives of an estimated two billion people worldwide. It is a medical rather than a lifestyle issue, and should be treated as such," says Dr Greg Hough, an endocrinologist who heads up the multi-disciplinary bariatric team at Netcare Greenacres Hospital in Port Elizabeth.
 
Professor Tess van der Merwe, internationally acknowledged obesity expert and director of the Centres of Excellence for Metabolic Medicine and Surgery (CEMMS) of South Africa, recently cautioned that diseases associated with obesity, such as type 2 diabetes, hypertension and ischaemic heart disease (IHD), were becoming increasingly prevalent in SA.

This is posing a serious challenge to both the public and private health sectors and needs to be urgently addressed. Locally, obesity has reached alarming proportions and is having a grave impact on the health and well-being of South Africans across the board, with as many as 10% of men and 28% of women classified as morbidly obese,” she said.
 
Body mass index (BMI) is used as an indicator to determine whether or not weight could pose a problem. Those with a BMI of more than 30 are considered obese while a normal BMI is between 18 and 25.  
 
"Of the morbidly obese patients (BMI>40), 85% will fail to lose weight and maintain the loss over the long term, despite lifestyle modification measures," says Dr Hough. "For them it is generally not shifting the weight that is the problem but being unable to maintain the required weight loss. People who have tried and failed repeatedly add other problems to their initial, inherited susceptibility to weight gain, such as a slowed metabolism, glucose intolerance and depression to mention a few.  All these unfortunately predispose them to further weight gain," adds Dr Hough.

Complications of obesity

"Obesity is the root cause of many metabolic and endocrine diseases, which are disorders in the endocrine system, a network of glands that produce and release hormones assisting with important body functions such as the ability to change calories into energy," according to Dr Hough. "This includes type 2 diabetes, high cholesterol levels in the blood, high blood pressure, non-alcoholic fatty liver disease, polycystic ovarian syndrome – a health condition that impacts hormone levels, periods, ovulation and ultimately fertility – and sleep apnoea, a potentially serious condition that occurs when the walls of the throat come together or collapse during sleep, blocking off the upper part of the airway causing a disruption in sleep. 
 
"Unfortunately, these diseases are often treated in isolation while the underlying cause of obesity is ignored," asserts Dr Hough. "Through weight loss, many of these diseases can be reversed and prolonged remissions achieved. Bariatric surgery is considered by many experts to be metabolic surgery because weight-loss and other metabolic improvements are driven by changes to gut hormones as a result of the surgery."

What does surgery entail?

Gastric bypass surgery stops the normal signalling from the stomach to the appetite centre in the brain, thereby effectively reducing food cravings. The small pouch at the top of the stomach, created during the bariatric surgery, quickly fills and stretches, which activates signals to the brain to powerfully switch off appetite and prevent over-eating.

Bypassing the first part of the small intestine results in dramatic changes in gut hormones secreted from here in response to food, restoring the hormones to levels seen in lean individuals. This results in improvements in diabetes, blood pressure and cholesterol, which occur so impressively from the first day after the surgery.
 
According to general surgeon, Dr Nico van Niekerk, who practises at Netcare Greenacres Hospital, the Roux-en-Y gastric bypass is the most well researched weight-loss procedure with the lowest overall complication rate of all the different types of surgery that are available. The outcomes of the Roux-en-Y gastric bypass surgery can bring about a loss of about 70% of the patient’s excess weight.
 
"The procedure leads to rapid initial weight loss with a plateau being reached after approximately two years. The maintenance of weight loss has been demonstrated in ongoing 16-year long clinical trials. The procedure is beneficial to the majority of obese patients who have multiple metabolic complications and considerable improvements in certain complications of obesity have been noted.

"Diseases such as diabetes have shown a resolution or remission in 84% of cases while high cholesterol normalised in 97% of cases and high-blood pressure in 68% of patients. As many as 80% of patients suffering from sleep apnoea prior to surgery, saw a remission or resolution in their condition."

Who should consider gastric surgery?

"This is a very important and life-changing decision and we therefore put all patients through a stringent screening process," says psychologist, Konrad van Staaden, who works with the team providing support and counselling services to bariatric surgery patients at Netcare Greenacres Hospital.
 
The multi-disciplinary team of healthcare professionals includes an endocrinologist, general surgeon, dietician, psychologist and anaesthetist. "We have to be very sure that each patient is committed and able to maintain the necessary nutritional adjustments and changes in lifestyle," explains Van Staaden.
 
"To qualify, a patient must have a BMI of more than 40 and will need to show that he or she has tried repeatedly and without success to achieve weight loss through a range of means. Patients must be older than 16 and younger than 65. Suitable candidates must be prepared for lifelong follow-up, must be well informed and motivated and have an acceptable risk for surgery. Following assessment, patient eligibility is confirmed by all members of the bariatric team," explains Van Staaden.
 
Bariatric surgery at Netcare Greenacres Hospital


All surgery is done in strict compliance with the rules and regulations of CEMMS (Centres of Excellence for Metabolic Medicine and Surgery of SA).
 
These guidelines require a team approach to the selection of suitable surgical candidates, pre-operative preparation, peri-operative care and life-long post-operative follow-up to ensure on-going good health. The surgeon, endocrinologist, and other team members as well as the hospital are fully accredited and are registered with the CEMMS to perform this procedure.
 
For more information on bariatric surgery at Netcare Greenacres Hospital, contact Estelle on (041) 363-5249.

 - (Netcare Greenacres Hospital press release)


 
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