Gastric Banding was very popular – made more so by “Celebrity Banders” and often it is the first thing anyone thinks of when Weight Loss Surgery is mentioned.

Those who are seeking a surgical option to deal with their obesity problems often have chosen the band because it is relatively cheap (compared to some other surgeries) and doesn’t involve any cutting of internal tissue or re-routing of the intestines. The Banding procedure does seem to generate more long-term problems than all the other surgeries, though. A recent study I read showed over 25% of Gastric Bands had to be removed within 3 years!  An article this month explains that Sleeve Gastrectomy replaces gastric banding in USA as the most “popular” Obesity surgery.

“Laparoscopic sleeve gastrectomy has now largely replaced gastric banding as a bariatric procedure in academic centres in the USA, according to a paper published in the Journal of the American College of Surgeons.

The study examined the popularity of procedures between October 1 2008 and September 30 2012. It found that by 2012, gastric banding made up 4.8% of all bariatric operations performed in US academic hospitals, a drop from 23.8% four years earlier. Over the same time period, sleeve gastrectomy rose from 0.9% to 36.3%.”

Gastric Plication the so-called “Gastric Wrap”, though still a relatively new procedure has all the advantages of banding – no cutting of stomach tissue, no “re-plumbing” of the small intestine, but does NOT involve mechanical foreign objects in the patient’s abdominal cavity, and the weight loss results appear far superior than those from Bands. This does seem to pose the question why would anyone choose a band these days – unless they have no other choice!

Here is a photo of some of the Gastric Bands recently removed from patients by Dr Michal Cierny in the course of revision surgeries

Price isn’t everything though, and it is important that you find out EXACTLY what is being offered. You obviously need to check on the surgeon’s level of expertise and his track record on the procedure you are planning, but there’s more to consider.

Bariatric Surgery is quite unlike most surgical procedures

With most forms of surgery, the procedure is carried out then (hopefully) the problem is fixed. Bariatric surgery is different. The surgery in itself DOESN’T immediately fix the problem, it simply gives you a tool which you can use to fix it yourself – a “sleeved” or “wrapped” stomach, a bypass or a band.

You wouldn’t expect to be able to drive a car or fly a plane without proper training, yet some surgery providers (and some surgeons) assume you can have the surgery and that’s it. You then are left to learn how to use it yourself, or ask questions on forums, where the answers may conflicting, often not accurate and usually only reflect the writer’s own experience.

The result is that patients go for their surgery with high expectations and can end up struggling to lose weight, or wondering why others seem to be doing so much better than they are with their weight loss.

It is SO IMPORTANT to be given accurate information, proper coaching and preparation to ensure the surgery can be carried out safely, to be given full and detailed tests before the surgery goes ahead and to be provided with a structured plan to follow for life after surgery.

To make a success of your weight loss after your operation you will need the right level of support, both psychological and nutritional, from advisors who are fully trained and experienced in what they do, and have been able to answer any concerns or difficulties you express from time to time in your weight loss journey based on their experience of helping many other patients who have encountered the same issues.

If the surgery provider you are considering does not offer all this then even though they may appear to be a “bargain” in the end you will pay dearly, because when you analyse it you are NOT paying a substantial amount of money to just to have a surgical procedure carried out on you, but to get yourself the best chance possible to lose your excess weight and keep it off forever. It is extremely difficult to do this without good advice and back-up.

We post this advice because at CB we have become concerned in recent months over the growing number of post-operative patients from other providers who have asked us for help. Our support and advice can only be for CB patients, but we are now in the process of developing a programme for patients who have failed following surgery elsewhere, to offer clinical investigation and (if needed) revision surgery coupled with a structured plan to ensure adequate weight loss thereafter

Kelly Thomas, who had the Sleeve Gastrectomy carried out by Dr Michal Cierny in 2008 was featured in a two page spread in Take a Break magazine 10th January edition.

Kelly, from South Wales weighed almost 30 stone before her surgery. She lost her excess weight quite quickly, and returned to Brno to us for a series of cosmetic surgery operations to correct the loose skin after such a drastic weight loss. She recently found her soulmate and has married – a very happy ending.

Melissa Foreman had her Gastric Wrap (Gastric Plication) with us in May of 2012. She appears, again a two page spread, in the 31 Jan edition of Pick Me Up magazine.

Mel was 22 stone before her surgery, and now, only 9 months later is trim and looking great.

In case you missed the stories here are copies of the pages from the mags (click to enlarge):

Kelly Thomas – Sleeve Gastrectomy – Take a Break Magazine – 10/01/13

Melissa Foreman – Gastric Wrap – Pick Me Up magazine – 31/01/13

Your diet following Bariatric Surgery should have a high proportion of protein in relation to simple carbohydrate. Apart from keeping you feeling full, and tasting pretty good remember that of all the cereals, porridge has the highest proportion of protein !

Here is a list of some of the benefits of such a simple food

HELPS LOSE WEIGHT

Researchers at Oxford Brookes University found that Foods with a low GI rating release glucose into the body more slowly and evenly, leaving you feeling fuller for longer. Those eating foods with a low glycaemic index (GI), such as porridge, were less likely to binge on sugary snacks. Porridge oats are 100 per cent natural, with no added sugar, salt or additives, and are naturally low in calories. An average bowl of porridge made with water contains about 170 calories (about 220 with Semi-Skimmed Milk)

LOWERS CHOLESTEROL & FIGHTS HEART DISEASE

Porridge is rich in soluble fibre, which has been shown to lower blood cholesterol. High cholesterol occurs when fat builds up and constricts the arteries, reducing blood flow to the heart. Eating oats can improve blood flow and bind to cholesterol in the gut, aiding its removal from the body. Scientists think the cholesterol-lowering effects of oats are due to the oat soluble fibre beta-glucan. Many studies have shown that eating fibre-rich food such as porridge reduces the risk of heart disease. Porridge contains avenanthramides – chemicals that stop blood cells sticking to artery walls, preventing the fatty deposits that cause heart disease

PREVENTS CONSTIPATION & HELPS DIGESTION

High-fibre foods such as porridge increase the movement of food through the digestive tract. This increased bowel action provides a good environment for beneficial bacteria in the gut to ferment while decreasing levels of destructive bacteria. Oats neutralise acidity levels in the body and help absorb toxins. Porridge also contains one of the highest levels of soluble fibre of any cereal. Soluble fibre is essential for healthy digestion.

REDUCES BLOOD PRESSURE

A daily serving of oats can improve blood pressure control and reduce the need for anti-hypertensive medication.  According to U.S. researchers, 73 per cent of those fed a wholegrain oat-based cereal (containing 3g of soluble fibre) stopped or reduced their blood pressure medication by half.

BEATS DEPRESSION & HELPS IN QUITTING SMOKING

Porridge is high in Vitamin B6, which promotes the brain chemical serotonin. High levels of serotonin are associated with feelings of well-being and also aid relaxation and restful sleep. Levels of serotonin dip when sunlight is limited – i.e. during winter – and can lead to the depressive condition Seasonal Affective Disorder. Compounds in oats can help calm the nervous system and reduce the craving for nicotine.

BOOTS ENERGY & HELPS CONCENTRATION

Porridge oats are high in complex carbohydrates and soluble fibre, which means they release energy slowly. A bowl of porridge should provide all the energy you need until lunchtime. The slow releasing complex carbohydrates in oats sustain energy levels, allowing full concentration to be maintained. Complex carbohydrates also stabilise and raise blood sugar levels.

SLOWLY REDUCES DIABETES RISK

Digested foods such as porridge might cut the risk of developing non-insulin dependent diabetes by absorbing sugar from the gut and cutting the need for large quantities of insulin to be released.

FIGHTS OSTEOPOROSIS

Porridge oats when blended with milk, make an excellent source of calcium which is essential for bone health. Lack of calcium can lead to osteoporosis, which involves a loss of bone density and can make bones fragile.

GOOD FOR PREGNANT WOMEN

Porridge is a source of folic acid. Studies have shown that taking folic acid from before conception until the 12th week of pregnancy can reduce the chances of having a baby with spina bifida. Pregnant women need 400mcg of folic acid a day.

FIGHTS CANCER

Oats are rich in the antioxidant vitamin E, which protects the body from the damaging free radicals that can cause cancer. A diet high in soluble fibre foods such as porridge oats might also help reduce the chances of developing bowel, colon and breast cancer.

CONTAINS ESSENTIAL MINERALS

Porridge is a good source of manganese, which is essential in allowing the body to produce energy as well as helping to build bones and connective tissue. It also contains zinc, which is needed for normal growth, sexual development and reproduction, and a healthy immune system.

The company boasts that they now offer over 180 low and no-calorie options.

As a Bariatric Surgery provider, we deal with the terrible problems Obesity brings to individuals, and find this marketing exercise by Coca Cola both cynical and hypocritical.

Our patients are drawn from many different walks of life, racial origins, occupations and backgrounds. Some have become diabetic, some have hypertension or one or more of the other obesity-related health problems.

Eating habits vary between patients, of course, but over the years we have noticed some fairly common factors in the medical questionnaires submitted to us.

One which is worth noting is that over 50% of our patients are or have been taking anti depressant medication for more than 6 months This will be a subject for further posting later.

Another linking factor is that over 75% of patients consume Carbonated Drinks every day.

There is a growing body of evidence that over consumption of sugars and sugary carbohydrates – not fats – is the main culprit in the obesity epidemic. When trying to lose weight and restrict calorie intake many who are Obese look to switch to the “Zero/Low Calorie alternative”. Coca Cola claim this is part of their commitment to a healthier society!

The artificial sweeteners used in these products may actually do more harm than the sugar in the normal Coke! (or Pepsi). They certainly stimulate appetite, and cause drinkers to crave sugar and carbohydrates. There is plenty of scientific research to show this.

Here is an extract from an article by  Wendell Fowler, published in the USA 9th January this year, which puts the case against Aspartame and some other sweetners very well:

Aspartame, Equal or NutraSweet (the blue packages of artificial sweetener) are excitoneurotoxic carcinogenic drugs. NutraSweet contains three neurotoxins: methanol wood alcohol, aspartic acid used as pesticide and phenylalanine a brain tumor agent. Certain snakes, scorpions, frogs and fish are known for secreting deadly substances known as neurotoxins.

 The deceitful multi-billion dollar aspartame industry wants you to believe “aspartame kills” is an urban legend and that you’d have to drink 100 cans of diet soda a day to be harmed by aspartame; that’s a black lie. Aspartame was never and cannot be proven to be safe. For individuals who are overweight, not only is diet soda not a diet product, but it is a chemically altered, multiple sodium (salt) and aspartame-containing product that actually makes you crave carbohydrates and gain weight. It contains formaldehyde (embalming fluid) which is stored in the fat cells, particularly in the hips and thighs. The National Soft Drink Association did a 30-page protest in the ‘80s mentioning aspartame as unstable; they suggested that it depleted serotonin (a substance that tells you to stop eating when you’re full) which often triggers a carbohydrate binge. The Atlanta Journal Constitution reported back in 1998 that “Aspartame is a Pandora’s box of toxins and tumor agents that have 92 FDA acknowledged ways to ruin your life, death being one!”

So often I hear that patients go for surgery, and the only checks done by the hospital beforehand are a standard blood test and maybe an ECG. This of course, reduces the cost to the hospital, but is NOT good for the patient: it exposes them to danger and for “self paying” patients, it can result in a VERY high unexpected bill.

At CB we ask all patients to get the following pre-op blood tests done a few weeks before surgery, and these blood tests are repeated in the hospital on the day before surgery:

A full blood count (FBC) including: glucose serum and lipid levels, liver enzyme levels and white blood cell count, C-RP (C-Reactive Protein levels) This one is rarely done before surgery in the UK, but is a very useful indication of inflammation/infection, hormone levels -Cortisol, Prolactin, Thyroid values (TSH and T3 &T4) – again rarely done as routine, but can show up some underlying causes of obesity, and reveal some potentially serious health problems. Testosterone levels (for males)

We also advise all patients to take PPI drugs in the run up to surgery, to dispel possible Oesophagal/stomach inflammation or ulcers. It is surprising how many Bariatric patients have these problems, even when no obvious symptoms show.

Our typical pre-operative testing/screening in Breclav Hospital with Dr Michal Cierny is:

Blood panel & urinalasys   Upper GI x-ray   Abdominal Sonography (ultrasound) ECG

Full Spirometery (if required)  Gastroscopy (camera into the stomach via the throat) – done under sedation  (this is essential) Physical examination & test review by Internist, examination/interview by Anaesthesiologist, Psychologist interview/counselling, Surgeon interview.

So, why are all these tests so important?

Over the years we have had to postpone some patients’ surgeries because of finding previously undetected: Hepatitis, Ovarian Cancer, Stomach ulcers, Liver Tumors, Pre-cancerous Oesophagitis, Prolactinoma , and several less serious conditions such as large hiatal hernias. Whilst none of these conditions made Weight Loss Surgery impossible in the future, going ahead with the operation without treating them first could have put the patients’ lives in danger, and making the patient aware of them and giving the patient the opportunity to have them treated may well have saved a patient’s life.

What about the cost implications for “private” patients?

Of course it is cheaper to have surgery without proper in-depth testing, and no-one likes to spend money they are not required to, but here is a typical example of why such short-cutting backfires.

Let’s say a patient goes for surgery without having a Gastroscopy. Nothing is detected in the sketchy pre-operative tests at the hospital/clinic, but when the surgeon starts the operation he discovers a stomach ulcer. Any responsible surgeon would not continue a bariatric procedure in this case, so the surgery is aborted. YET THE PATIENT HAS STILL INCURRED THE COST OF THE OPERATION! I haven’t yet found any provider who would do the rescheduled operation for free (though I have heard some surgeons would not charge again for their own services ) still, the theatre and staff costs have to be paid a second time by the patient, as well as the costs of the hospital/clinic stay.

I think patients should be much more careful about finding out what is offered by their surgery provider, and if a full and detailed pre-operative screening isn’t carried out ask why…and ask what the costs are if they were to add it to the bill. Obesity surgery is NOT a simple routine procedure like having your ear syringed – though some patients do come to it with that preconception.

BE VERY CAREFUL – ask questions, get information! – after all, we opt to have Bariatric Surgery so that we can live longer, healthier lives – surely, then, we should make absolutely sure we are not risking our health (or our solvency) in doing so?

It is up to the patient to eat sensibly – just good healthy meals which are high in Protein, and contain veg and/or fruit, and not to constantly nibble on high sugar, chemically laden carb-based foods….and of course to do some exercise to help the process.

So why can’t some patients manage this? Why do they struggle?

When a patient is planning weight loss surgery, they should examine not only what they eat, but when and why.  After surgery, the reasons we became obese and had a problem will still be there, and  to succeed in weight loss, the post-op patient needs to address problem issues around their “out of balance” relationship with food.

It is a mixture of psychology and the wrong  foods we have got used to eating because they”taste good”  (even when we KNOW they are bad)

Check on F.L.A.B. -eating when Frustrated, Lonely, Anxious or Bored. See what triggers these feelings and look for other things to do when feeling this way. Keep a food diary, and try to avoid eating later in the evening. Get active, it not only speeds up your metabolism and makes you feel physically better, it makes you feel better about yourself, too.

It seems that sugar, and the physical and emotional effect it has is much more of a danger that “high fat” foods ever were. Maybe sweet stuff gives you a pleasant feeling, but it certainly won’t help you reach your goal. Zero calorie soft drinks and foods are just as bad, they really stimulate the appetite – your system gets the sweetness, and expects a sugar kick…..but the sugar isn’t there, so soon afterwards you feel hungry.

Here are a few simple rules which will help.

1) Don’t eat sweet, or artificially sweetened things as snacks, and stay off the “diet” drinks

2) Crisps, cakes and ANY highly processed foods (shop or supermarket bought, “manufactured” foods) are NOT GOOD for you – far too many chemicals and additives, avoid them. For your meals TRY to make them up from natural ingredients – then YOU are in charge of what is in them!

3) Make up some snacks to eat in the day – nibble on bits of fruit, veg, a handful of nuts, grapes, a banana, sprouting seeds or a yoghurt. Plan your snacks in the morning – don’t buy the muesli bar from the shop, thinking it is “healthy”, this is just “impulse” buying and it was your impulses that got you obese!

4) DRINK MORE !!! – Preferably water, and not artificially sweetened juices. Have a half pint an hour or two before going to bed, rather than something to eat.

5) Do some exercise, move around, walk, swim jog whatever – you don’t need to join a gym, just be more active.

6) Every time you get the urge to nibble on something nice, rewarding, comforting when it isn’t a mealtime, stop and think, then make a cup of tea, or have a glass of water, and pause to see if there is something else you can do instead of eating.

7) Make use of other people, build a network of support and get and give encouragement. EVERYTHING is harder to do on your own!

8) Remember F.O.G. – when looking at what to buy to eat for your meals, if it comes from the Farm, the Ocean or out of the Ground it is most likely good for you. If it comes from the supermarket, vacuum packed with enough preservatives additives, salt and trans-fats to fell an ox, it might taste OK, and it might be “convenient” but you really are better off without it. Learn to cook!….even something simple.

Sleeve Gastrectomy was the most frequently performed surgery, closely followed by Plication (Gastric Wrap) and then Bypass (Omega Loop & RnY). We had no Gastric Band patients in the year – this procedure has been pretty well replaced by Wrap and Sleeve, which are much easier to live with from a post-op patient’s point of view, and have a vastly reduced chance of post-op “issues”. We did have a fair number of revision surgeries this year – all involving conversion from Gastric Band to other procedures.

The most frequently recorded “co-morbidity” (Obesity related illness/medical condition) was High Blood Pressure, next was Type II Diabetes, then PCOS (Polycystic Ovarian Syndrome) and Sleep Apnoea.

It is worth mention that just over 35% of patients in the year worked in the Medical Profession – specifically NHS workers. Medical workers included Doctors, Nurses, Paramedics, Hospital/Practice Managers and Healthcare Assistants.

In view of this it seems surprising that some patients who come to us for bariatric surgery in Breclav Hospital with Dr Cierny still encounter hostility and ill-informed prejudice when they discuss with their GP or local practice manager their choice of surgeon and the fact that they are going outside the UK for their procedure.

Some even experience negative reactions – and a reluctance to co-operate in monitoring their health post-operatively simply because they are “going private” for their weight loss surgery, whether abroad or not– yet in every case they meet the NHS/NICE criteria in terms of their degree of Obesity. Yet, more often than not it is only because the NHS is unable to find funds to meet the demand that patients look for a surgical solution outside the NHS. If these patients do their homework well though, they often conclude that the standard of care and level of pre-operative testing and preparation for surgery and post-operative support can be much greater outside the NHS -and outside the UK – than if they “stayed in the system”.

We predict that the demand for surgery in 2013 will be higher – Obesity seems to be impossible to bring under control in our society, and so far surgery is the only proven method for morbidly obese individuals to bring their weight within “normal” range.  Laparoscopic Greater Curvature Plication will continue to become a more popular choice for surgeons and patients – even in the UK, as NICE in 2012 has issued guidelines/advice on this relatively new surgery.

It seems the writing is on the wall for the Gastric Band. It may be a relatively straightforward surgical procedure which many Bariatric Surgeons are familiar with, yet patients find it harder to succeed in losing weight with the band and too many bands have to be removed – for a variety of reasons – for Banding to retain its popularity with both surgeons and patients.