Lapband Seminar Port Lap Surgery
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Transcript of Lapband Seminar Port Lap Surgery
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Managing Obesity in Adults
“Laparoscopic gastric band surgery, a partnership in sustained weight loss”
Recent advances in surgical treatment for obesity
69 Lake Rd, Port Macquarie NSW
Dr George Petrou BSc (Med) MBBS FRACS
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Obesity: Definition
• Imbalance between calorie intake & expenditure• BMI (body mass index) = weight/height2
BMI > 25 = overweight (>50% adults)
BMI > 30 = obese (20% adults)
BMI > 35 = severe obesity (8% adults)
The most common chronic illness in the Western world
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The increase in severe obesity (USA)
Sturm R. Arch Intern Med 2003;163(18):2146-8.
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The weight problem in Australia today
NORMAL
BMI 18.5 – 24.9
OVERWEIGHT
BMI 25 – 29.9
Class I
BMI 30 – 34.9
Class II
BMI 35 – 39.9
Class III BMI 40
45% 4% 6%33% 12%1:10 of the Australian adult community
may have a BMI >35
BEACH 2003-2004 the Australian adult population data consistent with AUSDIAB data
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Health Risks and Increased Risk of Mortality
Diabetes Hypertension Sleep apnea Depression Joint pain Infertility Cancer Acid reflux Asthma
Calle EE, Michael MJ, Petrelli JM, et al. Body-mass index and mortality in a prospective cohort of US adults. N Eng J Med. 1999;341(15):1097-105. Flegal KM, Graubard, B. I., Williamson, D.F., Gail, M.H. Excess deaths associated with underweight, overweight and obesity. JAMA. April 20, 2005
2005;293(15):1861-1867.
0
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16 18 20 22 24 26 28 30 32 34 36 38 40 44
High riskMedium riskLow risk
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Diseases Attributable to ObesityRelative Risk of Developing Certain Diseases Over the
Next Decade For Men With BMI >351
0
10
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Re
lati
ve
Ris
k
Diabetes High BloodPressure
Heart Disease Stroke
1. Lopes HF, Egan BM. Autonomic dysregulation and the metabolic syndrome: Pathologic partners in an emerging global pandemic. Arq Bras Cardiol. 2006;87:489-498.
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Pulmonary Disease Abnormal Function Obstructive Sleep Apnea Hypoventilation Syndrome
Nonalcoholic Fatty
Liver Disease Steatosis Steatohepatitis Cirrhosis
Coronary Heart Disease
Diabetes Dyslipidemia Hypertension
Gynecologic Abnormalities Abnormal Menses Infertility Polycystic Ovarian Syndrome
Osteoarthritis
Skin
Gall Bladder Disease
Cancer Breast, Uterus, Cervix, Colon, Esophagus, Pancreas, Kidney, Prostate
Phlebitis Venous Stasis
Gout
Medical Complications of Obesity1
Idiopathic Intracranial Hypertension
Stroke Catarac
s
Severe Pancreatitis
1. Obesity OnLine slide presentation. Accessed May 17, 2007. Accessible as slide #5 at http://www.obesityonline.org/slides/slide01.cfm?tk=33.
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BMI & death
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40016
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High riskMedium riskLow risk
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Does Weight Loss Make a Difference?
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Impact of Weight Loss on Risk Factors ~5%
Weight Loss5%-10%
Weight Loss
HbA1c
Blood Pressure
Total Cholesterol
HDL Cholesterol
Triglycerides
1. Wing RR, Koeske R, Epstein LH, et al. Long-term effects of modest weight loss in type II diabetic patients. Arch Intern Med. 1987;147(10):1749-53. 2. Mertens IL, Van Gaal LF. Overweight, obesity, and blood pressure: the effects of modest weight reduction. Obes Res. 2000;8(3):270-8. 3. Blackburn G. Effect of degree of weight loss on health benefits. Obes Res. 1995;3 Suppl 2:211s-216s. 4. Ditschuneit HH, Frier HI, Flechtner-Mors M. Lipoprotein responses to weight loss and weight maintenance in high-risk obese subjects. Eur J Clin Nutr. 2002;56(3):264-70.
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-15
-10
-5
0
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Short-term Obesity Therapy Does Not Result in Long-term Weight Loss
C
hang
e in
Wei
ght (
kg)
Source: Wadden TA, Sternberg JA, Letizia KA, et al. Treatment of obesity by very low calorie diet, behavior therapy, and their combination: a five-year perspective. Int J Obes. 1989;13 Suppl 2:39-46
5-YearFollow-up
End ofTreatment
Baseline
Diet alone Behavior
therapy Combined
therapy
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-2
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Long-term Weight Loss is Improved with Long-term Maintenance Therapy
W
eig
ht
Lo
ss (
%)
Source: Perri MG, McAllister DA, Gange JJ, et al.Effects of four maintenance programs on the long-term management of obesity. J Consult Clin Psychol. 1988 Aug;56(4):529-34.
0 1 2 3 45 67 89 10
11
12Time (mo)
13
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P<0.05
No maintenance txMaintenance tx
Diet andbehaviormodificationtherapy
18
I
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Weight loss sustained with surgery!
0
5
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0 1 2 3 4 5 6 7 8
Dieting
Exerscise
Diet and exercise
Diet exercise anddrugs
Surgery
Year
weight loss
%
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Resolution of Diabetes: Recent Data
0%
20%
40%
60%
80%
100%
Pontiroli,5 yr
Ahroni, 1 yr
Spivak,1.5 yr
Ponce,2 yr
Dixon,1 yr
Torquati,1 yr
Skroubis,2 yr
Pories, 2 yr
White,4 yr
Study
% R
eso
lved
RYGB
LAGB
Pontiroli AE et al. Diabetes Care. 2005;28:2703-2709. Ahroni JH et al. Obes Surg. 2005;15:641-647. Spivak H et al. Am J Surg. 2005;189:27-32. Ponce J et al. Obes Surg. 2004;14:1335-1342. Dixon JB, O'Brien PE. Diabetes Care. 2002;25:358-363. Torquati A et al. J Gastrointest Surg. 2005;9:1112-1118. Skroubis G et al. Obes Surg. 2006;16:488-495. Pories WJ. Presented at: NAASO-The Obesity Society Annual Scientific Meeting; October 20-24, 2006; Boston, Mass. White MA et al. Obes Res. 2004;12:949-955.
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Most Common Surgical Options Gastric Bypass
(GBP)
The LAP-BAND® System Adjustable Gastric Banding
Sleeve Gastrectomy (SG)
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The LAP-BAND ® System
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Am I a candidate for Surgery?
NORMAL
BMI 18.5 – 24.9
OVERWEIGHT
BMI 25 – 29.9
Class I
BMI 30 – 34.9
Class II
BMI 35 – 39.9
Class III BMI 40
45% 4% 6%33% 12%
* BMI (Body Mass Index): A measurement of an individual’s weight in relation to height (kg/m2).
1:10 of the Australian adult community
BEACH 2003-2004 the Australian adult population data consistent with AUSDIAB data
Potential candidates for surgery
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How much weight will I lose?Slow, gradual weight loss (0.5 kg per week)
60% excess weight loss in 2 years
Requires life-long commitment to change
Requires long-term follow-up
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The LAP-BAND® produces similar sustained weight loss as more
invasive surgery
%EWL
Years of Follow Up
O’Brien P, McPhail T, Chaston T, & Dixon J Obes Surg. 2006: 16; 1032-1040.
Weight loss is gradual!
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BUT HOW DOES IT WORK?
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The LAP-BAND® System Allows You to
Tame Your Hunger!
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The LAB-BAND® System acts by allowing small meals to satisfy for a long period – You can choose to eat less without becoming hungry. It “Tames Hunger” providing a tool you
can work with to allow significant weight loss
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The LAP-BAND® System Is Affordable
Private health insuranceReimburses cost of LAP-BAND device, theatre staff, time
and equipment to do operationReimburses most of hospital stayThere are “out of pocket” specialist fees
Can I take out insurance now? YES
BAND adjustments- $15 “out of pocket” charge per adjustment
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Next Steps If you would like to schedule a consultation to
see if the LAP-BAND® System is appropriate for you:– Contact our reception (02) 6584 3268
69 Lake Rd, Port Macquarie 2444
Reception @portlapsurgery.com.au