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

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

The increase in severe obesity (USA)

Sturm R. Arch Intern Med 2003;163(18):2146-8.

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

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

50

100

150

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250

300

350

400

16 18 20 22 24 26 28 30 32 34 36 38 40 44

High riskMedium riskLow risk

Diseases Attributable to ObesityRelative Risk of Developing Certain Diseases Over the

Next Decade For Men With BMI >351

0

10

20

30

40

50

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.

BMI & death

0

50

100

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350

40016

18

20

22

24

26

28

30

32

34

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38

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44

High riskMedium riskLow risk

Does Weight Loss Make a Difference?

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.

1

2

3

3

1

2

3

3

4

-20

-15

-10

-5

0

5

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

Weight loss sustained with surgery!

0

5

10

15

20

25

30

0 1 2 3 4 5 6 7 8

Dieting

Exerscise

Diet and exercise

Diet exercise anddrugs

Surgery

Year

weight loss

%

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.

Most Common Surgical Options Gastric Bypass

(GBP)

The LAP-BAND® System Adjustable Gastric Banding

Sleeve Gastrectomy (SG)

The LAP-BAND ® System

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

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

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!

BUT HOW DOES IT WORK?

The LAP-BAND® System Allows You to

Tame Your Hunger!

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

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

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