Weight loss _bariatric_ surgery

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					Patient information

Weight loss (bariatric) surgery
Bariatric surgery, or weight loss surgery,     Health improvements after weight
refers to the operations designed to reduce    loss surgery
weight (bariatric comes from Greek
                                               Cure of diabetes            50-85% of
meaning weight). Operations work by
restricting the amount you are able to eat
and/or reducing the amount of food you         Improvement in              80-95% of
can absorb. The term does not include          diabetes                    patients
procedures for surgical removal of body fat    Cure of high blood          40-68% of
such as liposuction or abdominoplasty          pressure                    patients
(tummy tuck).                                  Improvement or cure of      70-95% of
                                               sleep apnoea                patients
The two most widely performed procedures       Reduction in risk of        25-40%
are the adjustable gastric band and the        death (particularly from    reduction in risk
gastric bypass. All operations are usually     heart disease and           of death
performed laparoscopically (by keyhole         cancer)
surgery), which will help you to get up and
around and back to normal as soon as
                                               Am I suitable for surgery?
possible after surgery.
                                               You need to consider many factors before
                                               deciding if weight loss surgery is right for
Most people who undergo bariatric surgery
                                               you. As you go through the decision
lose a significant amount of weight. After
                                               process, ask yourself if you are up to the
they lose the weight, they are also more
                                               challenges you will face. First of all, you will
likely to keep it off provided they continue
                                               be required to have a full medical
to observe the amount of food they eat.
                                               assessment to ensure that you are fit for an
Scientific research demonstrates that
                                               operation. Weight loss surgeries are major
obesity surgery resulting in weight loss can
                                               operations that involve risks and may lead
reduce health problems considerably, as
                                               to significant short-term and long-term
shown in the following table:
                                               health complications. The risks and
                                               complications vary according to the types
                                               of surgical procedure you elect to have and
                                               often depend on your age, level of excess
                                               weight, other existing health conditions,
                                               and how well you manage your health and
                                               your lifestyle.

Bariatric surgery, January 2009
Patient information – Bariatric surgery

Before being considered for surgery you         − You belong to one of the following
will have a comprehensive psychological           categories:
and behavioural assessment. Significant            o Severely obese (BMI 35-39.9) with
psychological issues that may affect your            co-morbidity e.g. type 2 diabetes,
ability to care for yourself after surgery           high blood pressure, osteoarthritis.
would make it too risky to undergo surgery.
                                                   o Morbidly obese (BMI >40)
Weight loss surgery is only the first step in
                                                (BMI = Body Mass Index - is a measure of
a series of lifestyle changes that you will
                                                your weight in relation to your height and is
need to adopt in order to lose weight and
                                                calculated by taking your weight in
stay healthy. You will be required to attend
                                                kilograms (kg) divided by your height in
regular hospital appointments after surgery
                                                metres squared (m2).
and completely change the way you eat.
This will involve choosing healthy foods,
eating much smaller portions and taking         Your Primary Care Trust (PCT) controls the
daily nutritional supplements. Regular          local health budget and has to decide on
exercise is strongly encouraged before and      the priorities for your community. Your PCT
after surgery. Exercise preserves lean          must agree to fund your treatment for your
muscle tissue when losing weight rapidly        bariatric surgery to go ahead. Patients with
after surgery and may also help reduce          a BMI of over 50 (or over 45 with an
appetite. Exercise may also help reduce         obesity-related illness) are eligible for NHS-
surgical complications, promote healing         funded treatment. We need to make you
and enhance recovery after surgery. You         aware that most Primary Care Trusts will
must be committed to making these               not fund surgical removal of excess skin
lifestyle changes and attending your            resulting from weight loss surgery.
appointments.                                   We require a referral letter from your
Weight loss surgery is usually reserved for     GP, which should be addressed to Dr
people who are seriously overweight, and        Mohgah Elsheikh, Consultant Physician,
who continue to have a longstanding             before an appointment can be made.
weight problem despite making numerous
attempts to lose weight.                        Multidisciplinary Obesity Specialist
To be considered for surgery you must           Team
meet guidelines set out by the National
                                                Our service offers you the opportunity to
Institute for Clinical Excellence (NICE):
                                                see various specialists to ensure that you
− You must be willing to see various            get the best treatment, safely – these
  specialists that we recommend.                specialists together are known as the multi-
− You are generally fit for anaesthesia         disciplinary team. The team members are
  and surgery.                                  as follows:
− You are aged between 18-60 years.             Obesity Physician and Endocrinologist –
− You commit yourself to the need for           Dr Mohgah Elsheikh
  long-term follow-up.

Bariatric surgery, January 2009
Patient information – Bariatric surgery

Upper GI and Obesity Surgeons –                   for the rest of your life. Your operation
Mr Tom Dehn and Mr Michael Booth                  will be scheduled only if you achieve
Anaesthetists – Dr Jerome Cockings and            this target.
Dr Kathy Krzeminska                            − Cigarette smoking – surgery
Clinical Nurse Specialist                        represents a turning point in your life so
Obesity Specialist Dietician –                   if you are a smoker, now is an excellent
Mrs Lisa Lovell                                  time to give up. Smokers are much
                                                 more prone to experiencing problems
Obesity Clinical Psychologist –
                                                 with anaesthetics and recovery from
Mrs Jane Hazeldine
                                                 surgery. Please stop smoking for at
Interventional and Bariatric Radiologist –       least one month prior to your
Dr Naid Rahim                                    surgery. This really does make a big
                                                 difference to the anaesthetic.
− You will have been seen by members of        Appointment with the dietician
  the multi-disciplinary team and would        All patients will be asked to see the
  have completed a series of in-depth          specialist obesity dietician at initial
  assessments to ensure that all aspects       assessment. All patients must attend these
  of your obesity and other medical            appointments to move forward with the
  conditions have been taken into              assessment process. You will be advised
  account when making the decision             on how to lose weight before surgery – it
  about whether surgery is the most            will make the surgery easier and will
  suitable option for you.                     reduce the risks associated with it.
− The team members will give you               You should use the assessment period as
  detailed information about the different     a great opportunity to kick-start your weight
  types of surgery available, explaining       loss and also to help get into the habit of
  the pros and cons of each.                   eating a healthy diet. If you continue to eat
− You may be referred to other members         this way after the surgery you will manage
  of the multi disciplinary team for further   to successfully reach your weight loss
  assessments such as the psychologist,        targets.
  cardiologist or chest physician. Who
  you are referred to really depends on
                                               Psychology appointment
  your individual situation (which will be
  assessed for you).                           You will be referred to a psychologist for:

− A weight loss target to achieve before       − Assessment and treatment of bad
  surgery will be discussed with you in          eating habits, which may stop you from
  order that your risks at surgery are           losing weight after surgery.
  reduced and that you learn and practice      − Assessment and treatment of major
  the healthy eating and exercise habits         mood disturbances that may lead to
  that will be necessary after surgery and       comfort eating.

Bariatric surgery, January 2009
Patient information – Bariatric surgery

− Excluding major psychiatric illness that     Pre-surgery review appointment
  may render you unsuitable for these          This appointment will be carried out by the
  types of surgery.                            obesity physician. The purpose of this
                                               appointment is to check the progress on
This assessment is a requirement for most      the following:
patients. If necessary, you will be referred   − Reports back from other assessments.
for specialist eating disorder treatment
                                               − Check the progress of weight loss.
before contemplating surgery.
                                               − Make sure that surgery is right for you
                                                 and that funding is in place.
Other specialist appointments to               If everything is in place, the consultant will
assess fitness:                                refer you to the surgeon.
Some patients are at a higher risk of
developing complications during or after
                                               Further information
surgery due to pre-existing illness. You
may be referred to:                            NICE (National Institute for Clinical
                                               Excellence) - Obesity: understanding NICE
− Respiratory (chest) physicians for:
                                               guidance - treatment for people who are
    o Sleep studies – if you are at risk of    overweight or obese
      stopping breathing when you are
      asleep (sleep apnoea).
    o Respiratory function – if you have
      breathing difficulty from lung
                                               For more information about the Trust, visit
                                               our website www.royalberkshire.nhs.uk
− Cardiologist for ECHO, ECG and/or
  Stress study – if you have or are at risk
  of developing heart disease.
− Endoscopy – if you have a history of
                                               Centre for Diabetes and Endocrinology
  significant acid reflux.
                                               Written: January 2009
                                               Review due: January 2010

Bariatric surgery, January 2009

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