Michael Dermody of Cosmetic Bliss – specialist provider of Weight Loss Surgery examines the reasons why some patients who undergo surgery are unable to maintain weight loss after the procedure, and offers some possible solutions.

After all else has failed over years – all the various diets, fitness and exercise plans, all the various weight loss regimes and appetite suppressing or “fat bustingâ€� drugs, Bariatric Surgery is seen the last chance to lose weight permanently by those suffering from Morbid Obesity. Rightly so! It isn’t a soft option or a quick fix, and many patients only reach the conclusion that surgery is the sole option left to them after months – often years – of pondering on it.

So why is it that even after surgery some patients still can’t seem to lose significant weight or can’t maintain the weight loss they achieved in the first months after the operation?

Bariatric Surgery is performed in order to restrict the amount of food which can be eaten at any one time, as in the case of such surgical procedures as Gastric banding (the Lap-Band) or Sleeve Gastrectomy (the “Gastric Sleeve�) or in order to both restrict intake and also to limit the body’s ability to absorb nutrients from the food which is eaten, by surgically shortening the small intestine (a technique called “malabsorption�) which is the purpose of the various different types of Gastric Bypass procedures surgeons carry out.

If you read through some of the Weight Loss Surgery forums – as I do – or if you have worked in the field of Obesity Surgery for any length of time – as I have – you can’t fail to come across patients who have had surgery, even the most drastic and complex forms of Gastric Bypass, and still can’t sustain weight loss. Why is this? You will hear lots of reasons put forward by the patients themselves, but far more often than not these are attempts to “blameâ€� the failure on outside reasons rather than looking within themselves and examining their own behaviour. “My band failedâ€� My band slippedâ€� The surgeon didn’t remove as much stomach/intestine as he should have.â€�

It is probably easier to first try to answer the “how?� question than the “why?� question.

What happens, in simple terms is this: either the patient after surgery eats too often, constantly grazing on food throughout the day, or eats a lot of food which is too high in calories (chocolate, high fat food, sugary drinks, alcohol) or does not attempt to increase energy output through reasonable exercise or a combination of these things.

The “why?� question is a bit more complex.

At Cosmetic Bliss we specialise in preparing patients for Weight Loss Surgery, accompanying them and taking them through their visit for the operation with our support at our partner hospital in Breclav in the Czech Republic, where the surgery is carried out by Dr Michal Cierny Ph.D, a leading Bariatric surgeon and specialist in the performance of Sleeve Gastrectomy. A multi-disciplinary team, which includes a psychologist with a considerable experience of exploring issues concerning obesity work with Dr Cierny to ensure surgery can be safely carried out and that the patient is likely to be capable of succeeding in long term sustained weight loss following the operation. We also commit ourselves to supporting and advising our patients in the months and years after surgery.

When preparing patients for surgery, even at the “initial information� stage, we put a great deal of emphasis on the requirement for a patient to be fully prepared for surgery. Surgery will bring many changes, and patients need to be aware of this, and have some coping strategies in place to help them adjust their relationship with eating. We stress the fact that success is only 25% down to the operation and 75% down to the patient themselves, and their determination to make it work. We tell all patients SURGERY NOT A MAGIC WAND! – weight loss after surgery requires effort and commitment, and it is certainly not “the easy way out� as some of the media suggest ( and some advertising by surgery providers implies!).

No one gets to the point of morbid obesity unless they have real psychological issues which involve eating: it is self-deluding to pretend otherwise, and whatever “skeletons in the closetâ€� which may have caused an imbalance in the patient’s relationship with food will still be there after surgery. If comfort eating as a refuge from the bad things which have happened in life caused the obesity, what will happen after surgery, when the patient can’t eat in such volume? If failure to stick to healthy eating regimes before surgery was because of the patient’s view that failure – for them – is inevitable, how can we help them make changes in the way they look at life to allow them to break this vicious circle?

All too often, it seems to me, patients are not sufficiently encouraged to examine the reasons for their weight problems, and they decide on surgery with insufficient information (quite apart from a lack of information on the technical aspescts of what they are planning to do, but that is another story), insufficient self-examination and preparation, and unrealistic expectations of what surgery will do for them. The result is that they are “programmed for failure�. Overeating after a surgery which drastically restricts the stomach’s capacity can be very painful and unpleasant, and it is a measure of some post-operative patients’ inability to make the required changes, one could say almost a determination to defeat the purpose of their surgery that they are willing to put themselves through this discomfort and a real risk to their health.

The aim of Bariatric surgery is to achieve long-term sustained weight loss. it is a terrible disappointment for the patient in terms of their health, the investment they have made in time, money and the discomfort of going through an operation, and also in regard to their self-esteem and sense of achievement if they fail. It is the duty of those who advise and facilitate surgery to do all they can to ensure this does not happen.
Cosmetic Bliss patients have a very high success rate for long term weight loss following surgery. A patient’s success is not inevitable, nor is it guaranteed, but the seeds of success start with our being absolutely frank and honest about what surgery is, what it can and can’t do and what the patient must do to make it successful.
By working with our patients in this way, we can help them to be properly prepared for their surgery, and come to it with their eyes open.
This provides a very good start for a long, but ultimately very rewarding journey.

All information on Cosmetic Bliss Weight Loss Surgery Solutions can be found at http://www.cosmeticbliss.co.uk/p/weight-loss-surgery

Cosmetic Bliss have announced that they are now able to offer patients the Heliosphere Air-Filled Intragastric Balloon weight loss programme at their partner hospital Nemocnice Breclav in the Czech Republic. The cost – fully inclusive of flights, accommodation, transport, procedure – including removal of the Balloon after 6 months – AND a 2 year support package is only £3,400 (3,990 euro)
The procedure, which is performed by an endoscopic specialist (no surgical incisions required!) is a very useful addition to the range of Bariatric procedures (Gastric Banding & Sleeve Gastrectomy) the company provides. All weight loss patients are under the care of Dr Michal Cierny PhD – the renowned Bariatric Surgeon who performs all Cosmetic Bliss Obesity surgery, but this procedure will be carried out by Dr Martin Kriz, the Hospital’s Chief Surgeon and specialist endoscopist, and Dr Otto Riebel, the senior endoscopist.
Michael Dermody of Cosmetic Bliss said:
“The Gastric Balloon, which is put into the stomach for 6 months and allows patients to eat much less, thereby reducing food volume and calorie intake, is a very useful and proven medical Weight Loss procedure. It is ideal for those patients who are either just that bit too small for surgery such as a Lap Band or a Sleeve Gastrectomy, but still find it impossible to sustain weight loss by other methods. Also it can be useful if a patient has a medical condition which would not allow them to have surgery, or if their BMI is so high that surgery would be unsafe without first losing some weight.
We offered the saline filled BIB Balloon to patients for several years, but found that it was hard for some of them to tolerate it inside their stomachs. It took a lot to get used to – weighing more than half a Kilo when inflated! This new air-filled balloon, being double skinned and coated with pure gold on the inside (to prevent air molecules from escaping and causing the balloon to deflate) is more expensive, but because it weighs only 30g, patients find it much easier to get used to.
We tell everyone who comes to us for weight loss that NO procedure is a magic wand, and if they are to be successful they must change their diet and eating habits. The real secret is taking full advantage of the support we offer before and after the procedure. This is especially the case with the Balloon. It comes out after 6 months, and our patients must use the time it is inside to re-educate themselves and keep up the eating habits, portion control and increased exercise activity they have learnt. That’s why we have an extended 2 year support programme with nutrition, diet exercise and behaviour modification advice for Balloon patients – this is absolutely vital to make sure they get the most from it�
For more information visit http://www.cosmeticbliss.co.uk/p/weight-loss-surgery/gastric-balloon

On 1st November 2009 Cosmetic Bliss and Dr Michal Cierny PhD (Bariatric Surgeon) moved from the BMI Clinic in Brno where they had worked for over two years performing Gastric Band operations and Sleeve Gastrectomies, to Breclav Hospital near Brno.
The move was carried out to enable Dr Cierny to create a European Centre of Excellence in Bariatric Surgery. Dr Cierny plans to develop and extend his activities in the field of Bariatric Surgery by offering a wider range of procedures for Czech patients and also for patients from English-speaking countries who are brought to him and cared for by Cosmetic Bliss. The new centre, The Bariatric and Metabolic Centre, Breclav Hospital will fully integrate the disciplines of the dietitians, diabetologists, internal medicine specialists, anaesthetists and surgeon, and the comprehensive resuscitation, cardiac and ICU facilities of this large and well equipped hospital enable those patients with serious health problems to safely undergo surgery. Breclav Hospital is currently the only hospital in Europe to hold certificates for international standards ISO 9001. ISO 13001 and OHSAS 18001.
Dr Cierny said “I am more than ever convinced that it is vital to have a complete multi-disciplinary approach to the problems of obesity. Surgery is shown to be the long-term solution to morbid obesity, but surgery is only truly effective when the patients can receive the support and continuing encouragement and guidance of other professionals in the journey through their weight loss after their surgical procedure.”
Michael Dermody, one of the directors of Cosmetic Bliss, the UK company that arranges for English-speaking patients from UK, Eire and the USA to come for Weight Loss Surgery to Dr Cierny and Breclav Hospital welcomed this move, and suppported Dr Cierny’s comments. He added “I believe that psychological preparation for surgery, whether it is Banding, a Sleeve Gastrectomy, a Gastric Bypass or even a non-surgical intervention such as a stomach balloon is the most important factor in enabling the outcome of the procedure to be successful. I became even more aware of this during my own journey through weight loss after Dr Cierny performed a Sleeve Gastrectomy on me in September 2008. I have seen many cases of patients – both through the NHS and privately in the UK – going through weight loss surgery with inadequate preparation and information beforehand and little follow-up or counselling afterwards to enable them to understand the emotional changes and the changes in their relationship with food that weight loss after surgery brings about. We invest a great deal of our time and resources to ensure our patients are fully prepared for their procedure, and do our utmost to create a network of support, in terms of diet, nutrition and psychological assistance which our patients can call on in the months and years after their surgery. We really encourage our patients to maintain regular contact with us and with fellow patients. Quite honestly, Weight Loss Surgery is not a cheap nor an easy option, and it is wrong that people should make such a major investment, emotionally and financially, only to be left to fail because of inadequate preparation or poor support and follow up. In the UK, NICE (the National Institute for Clinical Excellence) has embraced the IFSO (International Federation of Surgeons in Obesity) criteria for acceptance of patients for surgical weight loss treatment, and part of those criteria involve careful psychological evaluation to ensure the patient is well placed to benefit from surgery. I know many UK PCTs set much tougher standards in terms of arbitrarily imposing higher BMI requirements on local candidates for surgery and this is clearly an attempt to limit the costs to the NHS of surgical procedures, but I believe they would be much better advised to concentrate on providing adequate support and counselling for those morbidly obese candidates for surgery they are able to afford to treat; in the long run this would prove a much more cost-effective option in terms of successful weight loss and the reduction of NHS costs in dealing with some of the co-morbidities associated with obesity such as Type II Diabetes and Hypertension”
Cosmetic Bliss is well placed to accept new patients for surgery with Dr Cierny in Breclav Hospital because of the new unit, though there is a waiting list of approximately 1 month.

Following a BBC 10-o’clock news item on Thursday 9th October on the dangers of having Gastric Banding in Belgium, Cosmetic Bliss, who, of course, co-operate exclusively with Dr Michal Cierny PhD in Brno, Czech Republic for all bariatric surgery felt the need to respond.
Cosmetic Bliss hold no brief for Belgian Weight Loss Surgeons, and strongly support IFSO guidelines on appropriate BMI levels being used as a factor in risk assessment of patient suitability for surgery. All surgery performed under general anaesthesia carries a risk however, and the laparoscopic techniques used in Gastric Banding and Sleeve Gastrectomies, although proven to have several advantages over open surgery, are not risk-free. Nevertheless, under the care of an experienced specialist surgeon such as Dr Cierny, and with the support of a good surgical team the risks of surgery for a patient are much smaller than the risks involved in remaining obese. It is the duty of the surgeon and his team to make an assessment of a patient’s
suitability for surgery on the basis of this risk assessment.

Here is the text of Cosmetic Bliss’ response to the BBC item:

“Following the report on BBC News concerning Gastric Banding in Belgium, we wish to make the following points.

1. No RESPONSIBLE bariatric surgeon, abroad or in the Uk would offer surgery on a patient that did not meet the IFSO guidelines on BMI (same as NICE guidelines), and those surgeons who do perform surgery on patients who fail to meet the guidelines do so for one reason only – MONEY!!

2. The fact that a patient is refused surgery under the NHS does not necessarily mean that they are not suitable candidates for bariatric surgery. The chief reason surgery is denied by the NHS is because of cost. The figures speak for themselves. In 2006 almost 750,000 UK residents met the NICE (& IFSO) guidelines for surgery – only 7,000 operations were performed. The health service simply cannot afford to offer surgery to more than a fraction of those “qualified” to have it. More often than not local health authorities set much higher limits on BMI before considering a patient for NHS Surgery. That is why most patients seek a solution in the private sector, and why such companies as ours exist.

3. We agree that support post-operatively is essential to successful management of obesity, but that too is not always available to patients who have had surgery under the NHS, and I do not agree with the secretary of BOSS – Alberic Fiennes’ assertion that post-band patients should need to have access to “immediate” adjustment to the band. If the adjustments are performed by either an experienced bariatric surgeon OR qualified bariatric nurse, they should be safe and effective, and not require “emergency” correction. We have safely and responsibly arranged and accompanied more than 100 patients for successful surgery in the last 12 months alone, and do think it is entirely unfair to promote the idea that responsible surgery can only be assured in the UK, that “Johnny Foreigner” is more likely to breach guidelines for profit than a UK surgeon, and that competent aftercare is only available in the UK from the NHS. Many surgeons who perform Gastric banding for NHS patients, where the NHS “barâ€� is set MUCH higher than the NICE/IFSO guidelines also perform the same operations on private patients with lower BMI.Expertise and a commitment to care is not confined to the UK or the NHS, and there is a whiff of Xenophobia in this report which maybe has more to do with retaining a profitable private business for UK surgeons than a real concern over patient safety. It was very noticeable that although the straw poll conducted by BBC News cited UK Bariatric surgeons who had treated patients who had gone abroad for surgery, the question of how many patients were treated following surgery – either through the NHS or privately in the UK was never asked. We feel that the BBC has departed from standards of fair and balanced reporting in this instance, and find this very regrettable.”

In a normal city you would expect a special bus line that goes from the international airport to the city center. Not everybody can afford a cab, and not everybody likes cabs as such.

In Brno, the airport is served by regular bus line number 76 that has about ten stops on the way to the center and thus is used also by people from the neighborhood the bus goes through. And it is also used by people who work in the industrial zone that neighbors the airport.

Result?

I took a test ride about three days ago. Six people boarded the bus at the airport, all of them had the now-favorite trolleys, huge suitcases on wheels. These suitcases jam-packed the aisle and seats. From the second bus stop on the way to the center it was practically impossible to board the bus as a normal passenger.

Brno Transport Authority should use special buses with less seats and more space for suitcases and luggage in general. It should not stop on the way between the two end-stations. I am quite sure airline travellers would appreciate it. And they would not need to ask the are-we-there-yet question, just like a certain U.K. couple did during my test ride.

Plus I can imagine a better route for the bus than the one it is taking now with the bus stops on the way. It goes through one street that is one of the worst in the city. Nothing to be proud of. Sometimes it feels as if a JFK shuttle on the way to Central Park West was going through the worst part of Harlem. No offense to New Yorkers….

Thanks to Petr Bokuvka 24/09 http://czechdaily.wordpress.com/page/5/

DON’T WORRY! COSMETIC BLISS PACKAGE CLIENTS HAVE TAXI TRANSPORT ARRANGED FOR THEM

Brits spending £161m a year on medical tourism
Last year over 50,000 Britons traveled abroad for low cost medical treatment, with trips for cosmetic surgery and dentistry among the most popular. A rapidly growing number of UK residents are now combining a few weeks in the sun with surgery for popular procedures such as breast augmentation, liposuction, tummy-tucks and teeth whitening.

Huge savings can be made by going abroad for treatment and this growing trend for medical tourism is set to soar with many people choosing to travel to exotic places as far a field as Malaysia and India with locations like Spain, Cyprus and Belgium among the most popular among British medical tourists.

An independent survey commissioned for TreatmentAbroad shows that savings of up to 80 per cent can be made on some cosmetic surgery and dental work with a tummy-tuck costing about £4,450 in Britain, whereas in Belgium it is only about £2,400.

The internet is the obvious first place medical tourists look to for advice on traveling abroad for treatment but with such a large number of countries offering competitively priced surgery and with so much choice it can be hard to make the right decision.
To make it easier for those wishing to travel abroad for surgery there are now many companies offering packages, which include travel, surgery and accommodation. Keith Pollard of treatmentabroad.net explains that:

“Many clinics and medical tourism companies are now offering an all-in package embracing all procedure, travel and accommodation costs that may offer additional savings. Patients who have become ‘medical tourists’ have been extremely positive about their experience and the quality of care they have received.�
Debi Robinson, one such patient from Middlesborough, used treatmentabroad.net to find a clinic in Eastern Europe. She paid £2,500 to have loose skin removed from her arms and stomach area which, even with the cost of accommodation and flights, meant that she paid less than if she’d undergone the same procedure in the UK.

“The difference in price was huge,” she revealed. “I would have to have saved up for ages to get it done in Britain.

By CTK / Published 20 August 2007
Prague, Aug 18 (CTK) – Czech plastic surgeon Bohdan Pomahac from Olomouc, north Moravia, has become head of a U.S. team that will become the third one in the world to transplant faces, Mlada fronta Dnes (MfD) writes today.

Another such workplace is only in France. It transplanted the face of a woman whom a dog bit out a cheek, the lips and the nose.

“The third clinic is in China but the doctors have not released any detailed data on the operations, so it is difficult to say how successful they are,” Pohamac, 36, told the paper.

He will head the burns clinic of Brigham and Women’s Hospital in Boston. At the same time he heads a team that will perform face transplants there.

The hospital has long been one of the ten best facilities in the United States where patients from all over the world are treated. One storey with luxury equipment is reserved for rich patients.

Story from Prague Daily Monitor 20/08/07

By Bernard Purcell – Irish Independent – Thursday July 26 2007
AIRLINES and airports will be banned from charging for assisting disabled and elderly passengers under new EU rules. Airlines, airports and travel agents will now be obliged to ensure that would-be travellers with reduced mobility are afforded the same levels of access as the able-bodied. The airlines and airports now have a change-over period of a year until the new rules can be enforced.

The rules have three basic principles: equal treatment of persons affected by reduced mobility; free assistance in all EU airports; and free assistance on board. Regular wheelchair users and blind people can expect their chairs and guide dogs to be carried for free when the new rules – agreed by ministers and MEPs a year ago – are fully in force throughout the EU by no later than July next year.

In addition, the definition of restricted mobility has been broadened to include a whole spectrum ranging from the physically and intellectually disabled to the elderly and infirm, to those recuperating from surgery.

Until now airports and, mainly but not exclusively, the low-cost airlines have argued between themselves as to who must provide the facility and who should pay the cost, sometimes resulting in legal action by passengers. “Most airlines and airports do make genuine efforts to offer the necessary assistance but not all of them provide comprehensive assistance, free of charge,” said the Commission.
 

By CTK / Published 31 July 2007 Prague, July 30 (CTK)

Most Czechs in favour of smoking ban in restaurants
- The number of Czechs who mind smoking in restaurants, bars and cafes is rising and over half of the population would like to ban smoking at such places completely, a poll conducted by the Median agency for the daily Mlada fronta Dnes (MfD) has revealed.

The results differ considerably from another poll made by the Eurobarometer agency half a year ago. Only one third of Czechs were in favour of non-smoking restaurants then,MfD writes today.

According to Median, 54 percent of Czechs want to ban smoking in restaurants completely. As many as 74 percent of them are non-smokers, the paper writes.

Smokers, on the other hand, do not like the idea of having to go out of the restaurant to have a smoke. Only 13 percent of them support a ban of smoking in restaurants, the paper adds.

The majority support for a complete ban of smoking in restaurants plays into the hands of the advocates of a new anti-smoking bill on which the lower house of parliament is to decide in September, MfD writes.

A bill by doctor Boris Stastny, an MP for the senior government Civic Democratic Party (ODS), does not suggest a complete ban of smoking in restaurants. That would have a small chance of succeeding in parliament, the paper writes.

Stastny proposes that restaurants obligatorily separate smoking areas from the non-smoking ones. The only difference from today’s habit is that the separation would not be just formal but that special rooms, separated from the non-smoking areas by walls, would have to be created, MfD writes.

By Ilya Marritz – Czech radio 23/1/07

Now some economists say it’s time for the Czech Republic to fully cash in on the price advantage, and specialize in medical tourism. Tomas Sedlacek, is chief economic strategist CSOB bank, and a former advisor to President Havel.
Lately he’s been talking up the idea of medical tourism, and says there’s a great deal of interest – from people in government, from doctors, and from other economists.
“You can make a very nice deal for foreigners. You know if you want a hip replacement you can either wait for 60 days in your home country or we can fly you to the Czech Republic first class. You can spend two weeks after the operation at a spa. We’ve done in our heads calculations and rough estimates, even if you do this it’s still half price of what it would cost in Western Europe. So for local insurance this would be good thing especially at first while prices are still low and people are not used to coming here for their medical care.”
You might call it reverse exploitation. It’s not simply westerners taking advantage of the low prices in the east, it’s the Czech healthcare system taking advantage of how much Western Europe’s health insurers, and private clients, are willing to pay.
“If we instead of shipping doctors to foreign countries, ship foreign patients here, we gain in many respects. Firstly, the good doctors stay here, secondly, the economy will profit, not only healthcare but the whole economy – the tourist industry because there will be other services joined to this core business.

http://www.radio.cz/en/article/87525