Anti-obesity drug sibutramine (Reductil) has had its licence suspended and GPs are being asked not to issue any new prescriptions for the drug. The suspension follows a review of the drug’s safety by the European Medicines Agency (EMEA) on the basis of data from the Sibutramine Cardiovascular Outcomes study.
This follows the suspension of the marketing authorisation for Accomplia (Rimonabant) in October 2008. The EMEA decided that the benefits of Acomplia, no longer outweighed its risks.

This leaves Orilstat (Xenical) which acts by reducing the body’s ability to absorb fats as the only major drug left in the GP’s armoury when attempting to manage obesity through conservative (non-surgical) means, although many patients find some of the side-effects of this drug unpleasant and/or embarrassing.

The review which brought about the suspension of Reductil concluded there was an increased risk of non-fatal heart attacks and strokes with sibutramine. The EMEA said that this risk outweighed the benefits of weight loss, which was modest and may not have been sustained in the long term after stopping treatment.
Prescribers are being advised by the MHRA not to issue any new prescriptions for sibutramine and to review the treatment of patients taking the drug. Pharmacists are asked to cease dispensing the medicine.
People who are currently taking sibutramine are advised to make a routine appointment with their doctor to discuss alternative measures to lose weight

Last year, 86,000 people were prescribed sibutramine on the NHS. The drug was licensed for as adjunctive therapy within a weight management programme. Its indication was limited to patients with either nutritional obesity and a BMI of at least 30 or nutritional excess weight and a BMI of at least 27 in those with obesity-related risk factors.

Surgical intervention for weight loss is, or should be, only considered for patients with a BMI of at least 40, or a BMI of at least 35 if they have other weight-related severe medical problems. For patients whose obesity is still a significant problem, but who do not qualify for surgery, the Intragastric Balloon is a procedure worth considering. It is designed to remain in the body for 6 months and enable the patient to lose (on average) between 10 and 30 KG, though careful management and long term dietary change must be part of the programme.
For further information on the Balloon and on Surgical solutions to Morbid Obesity please visit http://www.cosmeticbliss.co.uk/p/weight-loss-surgery

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

Many healthcare companies are in the market offering to organise and assist patients who have decided to “go private� for their procedures – either as a first choice or because surgery is simply not available to them under the national health scheme.
Most prospective patients, certainly in the UK and Republic of Ireland, arrange their private treatment through commercial providers and/or facilitators, rather than attempting to deal direct with the surgeon, and many providers offer a range of procedures, from Cosmetic Surgery, Dental Treatment or Laser Eye Surgery to Obesity Surgery and General Surgery.
It can be quite bewildering for the prospective patient who must not only attempt to learn as much as possible about the procedure they wish to undergo, but also try to select a surgeon and medical team they are willing to put their trust in, and to choose a company which will inform and guide them honestly and put the patient’s best interests above their own desire to “make a sale�.
Michael Dermody and Deborah Darling of Cosmetic Bliss – a private healthcare company which arranges weight loss surgery and post-weight loss cosmetic surgery in the Czech Republic for English-speaking patients are calling for better standards of clear communication and improved support by healthcare facilitators for their patients – especially in the field of weight loss surgery , their own specialist area.
Michael Dermody is quoted as saying
“Our company’s high reputation on the various weight loss forums is founded on our being able to provide thorough and extensive information to our patients pre-operatively, ensuring that they are properly prepared for their surgery; supporting them whilst they make the visit for the surgical procedure and being available to them during the period of weight loss after their surgery.
I think what makes us special is the “hand-holding� service we give whilst the patient is with us for surgery. We make sure we are there – in the hospital – with them throughout their stay, and this is something our patients really value above everything else. Of course we couldn’t do it without the co-operation we get from our partner hospital and surgeon.
We realised a long time ago that taking patients through weight loss surgery was very different from arranging Cosmetic Surgery – it is much more demanding, and requires a much greater commitment by the provider
Firstly, there is the matter of assessing the patient’s suitability for surgery. Quite apart from fairly rigorous pre-operative preparation and testing, some of which should be done well before the surgery itself, there is the issue of making sure the patient is really ready for surgery and prepared to make the mental adjustments, in terms of relationship to food which are necessary if the surgery is to achieve long-term weight loss. Then there is the question of putting in place for the patient an adequate system of support and monitoring during the months and years after the surgery. Unless all these things are done, and done correctly, there’s every chance a patient is wasting their money in having the surgery, as the whole point of the exercise is for the patient to achieve sustained, long term weight loss, not merely a good safe operation with clean scars!
It disheartens and worries me when I see that there are still some companies out there that sell weight loss surgery in a way I would expect to see furniture sold, with “special offer� discounts, and “last minute deals�. It all seems to diminish the serious nature of the surgery and the commitment the patient has to make. More alarming, though, is the lack of quality information provided by some companies – and in some cases positively inaccurate and misleading information is openly advertised on websites. There are still providers of weight loss procedures who advertise a Gastric Bands as being “the same as Gastric Bypass�, and even one promoting Intragastric balloons (a non-surgical temporary endoscopic procedure) as “Lap Bands� .
That’s no different from selling someone a cat, and telling them it’s a dog, on the grounds that “it’s the same thing�!
I know that many companies do a good job, but it is not fair or right to expect the enquiring prospective patient to be able to distinguish between accurate and misleading or inadequate information – especially as they often come to the marketplace having done very little research before contacting providers.
I firmly believe that there is a crying need for Private Healthcare providers and Medical Tourism companies to get together – probably in the form of a trade organisation – to set agreed standards of care, support and accuracy of information, and devise a form of accreditation – not only for the sake of their own reputations but in the interests of true patient care.
Our own facilities in Breclav Hospital are specifically geared to Obesity Surgery, and there are emergency and ICU departments on hand at this modern major hospital to enable us to safely cater for those morbidly obese patients who have other serious health problems. We are working closely with the hospital and Dr Michal Cierny PhD, the Specialist Bariatric Surgeon in charge of the Bariatric and Metabolic Centre there in creating a European Centre of Excellence in Bariatric Surgery.
We are currently actively seeking to co-operate with other providers and facilitators of Private Healthcare – especially in the UK, Eire, and North America – who have a close and trusting relationship with their patients and who share our own commitment to the quality of information and pre- and post-operative care standards for Bariatric patients I have described.
We are willing to develop working relationships with companies who wish to take full advantage of our facilities for safe surgery, and who will value the round the clock support we will be able to provide to their patients when they are with us for surgery. This will enable the provider to focus on putting in place a solid system of pre-and post operative support, and we would welcome enquiries from other Private Healthcare companies working in this field who are interested in developing such a relationship, and promoting standards of excellence in the area of Obesity Surgery and care and support in managing weight loss post-surgery.
We would welcome enquiries from Healthcare Providers and Facilitators, initial contact can be made with us through our website: http://www.cosmeticbliss.co.uk/p/contact

Despite the yearly rise in the numbers classified as “Morbidly Obese” in the UK, and the drain on public health resources due to the costs of treating chronic illnesses which are caused by this epidemic of obesity, the provision of Surgery as an option for patients is still very scant in most areas of the UK. An article in the Scotsman on 27/12/2009 stated that only 0.8% of Scots eligible and willing to go ahead with Obesity Surgery receive it. In England the situation is marginally better – 1.2%!!
When NICE (The National Institute for Clinical Excellence) issued Guideline 43 in December 2006, it clearly stated who should be considered for surgery – patients with a BMI of over 40 (or over 35 with obesity-related “co-morbidities�) who have exhausted attempts to maintain weight loss through more conventional methods. The guidelines also recommend Surgery as a “first line option� for patients with a BMI of over 50.
In Jan 2008 BOSPA (the British Obesity Surgery Patients’ Association) published a survey of the attitude of PCTs – those bodies in the UK who are responsible for allocating funding for surgery. Many did not respond, but of those who did around half confirmed they applied much stricter criteria when approving funding of surgery than the NICE guidelines. There remains no clinical justification whatever for denying surgery to patients who meet the NICE guidelines – so the practice of insisting on much more severe criteria before allowing surgery is clearly based on limiting cost. Local PCTs clearly have a finite budget with many competing demands, and Obesity surgery is potentially a great drain on their resources. The NICE guidelines are, after all, only guidelines and are not legally enforceable – though some patients have sought legal redress for the failure of their PCTs to adequately deal with their health problem.
It seems a very short-sighted approach, in terms of the PCTs duty to provide adequate healthcare, condemning obese patients to become more ill as the obesity-related diseases develop, and even from the cost point of view studies have shown that Obesity Surgery pays for itself over approx. 3 years, as the cost burden of treating co-morbidities such as Type II Diabetes is reduced in patients who have lost significant weight. The government makes little provision for tackling this epidemic, and largely leaves PCTs to “get on with it as best they can�
So, what can someone who is classified as Morbidly Obese, and needs surgery do?
It is possible to attempt to put pressure on your local PCT through your GP to approve surgery, but it is a long uphill battle, with very little prospect of success.
You can look for surgery privately, which is the course most obese patients follow.
There are problems and pitfalls here, quite apart from the cost you will have to meet.
Firstly you have to be careful to choose a surgeon, hospital/clinic and company, (if you arrange your surgery through a Healthcare company as most do) who are not only experienced in the type of surgery which will be best for you, but also you must be sure that all the pre-operative health checks and tests are at least as extensive as in the NHS. It goes without saying that every effort should be made to ensure your surgery is as safe as possible. Psychological evaluation and some counselling to ensure a patient is at the right point to be able to succeed with weight loss following surgery is absolutely vital. NICE recommends that obesity should be managed by a multi-disciplinary team, and that post-operative support is essential
Post-operative support – whatever the surgery – is very important and you should be careful to chose a surgery provider who is willing to offer this, and not simply prepared to leave it to your GP to give advice and help after the surgery.
Cosmetic Bliss http://www.cosmeticbliss.co.uk/p/weight-loss-surgery is a weight loss surgery company who arrange safe Obesity Surgery for English-speaking patients at the Bariatric and Metabolic Centre – Breclav Hospital in the Czech Republic with Dr Michal Cierny PhD the Bariatric surgeon. They have a great deal of experience in preparing patients and giving them sufficient information to ensure safe surgery. The hospital is working to become a European Centre of Excellence in Bariatric Surgery, and the pre-operative health checks and tests for patients are very extensive. Cosmetic Bliss accompany all patients throughout their stay at the hospital and provide a full system of post operative support, nutrition diet and exercise advice. They encourage regular post-operative contact and follow up with patients for a minimum of 2 years after surgery, and monitor post-operative outcomes and weight loss following surgery on behalf of Dr Cierny. They are keen to work with UK GPs in providing post operative support to all patients. Although initially many patients are a little intimidated by the prospect of having surgery abroad, the quality of care, the system of safeguards Cosmetic Bliss and the Hospital have put in place, and the hand-holding service Cosmetic Bliss provide whilst the patient is in Hospital make it a very reassuring experience. Prices are fully inclusive and the cost is significantly lower than arranging for surgery in the UK also.

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.

WLS Support, 9th November 2009

Patients who underwent weight-loss surgery are successful as they said “Stop� to obesity but it’s only one step in the long process of weight-loss. The main thing they have to remember is that nothing is going to be the same after the procedure. They have to change the style of life and introduce a healthy diet.

These are tips which will help to lose weight and maintain a healthy lifestyle:
~~ Eat nutritional food. Make sure it’s low-fat and low-sugar. Avoid carbohydrates, especially white rice and pasta.
~~ Eat good quality well balanced protein food.
~~ Do not skip meals.
~~ Exercise regularly a few times a week. In order to burn calories your heart rate should raise while exercising.
~~ Drink at least 2 litres of water per day. Do not overdo though, as it’s bad for your internal organs.
~~ Take note of everything you eat and how much exercise you do.
~~ Let yourself a treat from time to time but make sure it doesn’t become an obsession.
~~ Take vitamins and supplements, and remember to have your blood checked regularly.
~~ Do not beat yourself if you miss an exercise or eat something you should not. Just move on and get back to your healthy routine.
~~ If you find it hard to stick to the diet and exercise plan, join a support group.

Remember that the surgery has made a huge difference in your body. Do not let yourself down by coming back to the wrong habits. On the other hand, everyone’s different. Try not to compare yourself to other people. Listen to what your body is telling you. If you experience any unpleasant sensations or pains, contact the doctor as you might need to change something in your new lifestyle.

WLS Support, 9th November 2009

Patients who underwent weight-loss surgery are successful as they said “Stop� to obesity but it’s only one step in the long process of weight-loss. The main thing they have to remember is that nothing is going to be the same after the procedure. They have to change the style of life and introduce a healthy diet.

These are tips which will help to lose weight and maintain a healthy lifestyle:
~~ Eat nutritional food. Make sure it’s low-fat and low-sugar. Avoid carbohydrates, especially white rice and pasta.
~~ Eat good quality well balanced protein food.
~~ Do not skip meals.
~~ Exercise regularly a few times a week. In order to burn calories your heart rate should raise while exercising.
~~ Drink at least 2 litres of water per day. Do not overdo though, as it’s bad for your internal organs.
~~ Take note of everything you eat and how much exercise you do.
~~ Let yourself a treat from time to time but make sure it doesn’t become an obsession.
~~ Take vitamins and supplements, and remember to have your blood checked regularly.
~~ Do not beat yourself if you miss an exercise or eat something you should not. Just move on and get back to your healthy routine.
~~ If you find it hard to stick to the diet and exercise plan, join a support group.

Remember that the surgery has made a huge difference in your body. Do not let yourself down by coming back to the wrong habits. On the other hand, everyone’s different. Try not to compare yourself to other people. Listen to what your body is telling you. If you experience any unpleasant sensations or pains, contact the doctor as you might need to change something in your new lifestyle.

Atlanta Journal Constitution, 2nd October 2009

The latest researches carried out in U.S. showed that the sooner obese teenagers undergo weight-loss surgery, the better.

61 young patients took part in the study. They all had laparoscopic Roux-en-Y gastric bypass. A year after the procedure an overall BMI among the patients decreased by 37%. The patients were still considered as obese, due to their weight from before the surgery.

The research was the first one to show that young people’s weight influences in great respect their postoperative weight. The results were published in the Journal of Pediatrics on 23rd September.

Dr. Thomas Inge, a professor of surgery and pediatrics at the Cinnciati Children’s said: “Current guidelines for adolescent weight-loss surgery suggest that we begin to consider surgery only after a teen is 80 percent to 100 percent overweight.”

“Our new data show that when we intervene when a patient is between 100 percent and 150 percent over ideal weight, we can expect successful resolution of obesity. But by the time the teen is 200 percent over their ideal weight for age, the surgery will reduce their weight substantially, but many of the patients will still remain morbidly obese,” he added.

The conclusion from the study is that waiting too long with the weight-loss surgery might not make the procedure successful enough. It means that both obesity as well as related medical problems might not be 100% cured if proceeded too late.

What can be done about that? Both doctors as well as teenagers’ parents should be able to identify the problem when they gain too much weight in a short period of time, and help them as soon as possible.