The news Today September 5, 2008

Obesity is a huge problem nowadays. More than 33% Americans have weight problems. That is why weight loss surgeries became extremely popular over the last years. The procedure carried most often is gastric bypass surgery. The other popular solution is gastric banding. Some surgeons even say that it is safer, more effective and has fewer side effects than gastric bypass.

Batriatic surgery, simply speaking, is an operation on the stomach letting obese patients to lose and maintain normal weight, using healthy diet in the same time.

During the operation the stomach volume is reduced by 95%. It means only 5% of the food can be absorbed. Also a small part of the upper intestinal track is being bypassed. Thanks to that the patient does not need to eat that much as he/she feels full after having just a small amount of food. The procedure reduces the appetite and the amount of calories taken.

Gastric bypass is a very effective operation allowing patients to lose 65% to 75% of weight. Obviously a strict diet needs to be followed after the surgery as eating more will negate the effects.

The other very popular weight-loss surgery is gastric banding. This procedure consists of placing a silicone band inflated with saline on the top of the stomach. As in gastric bypass, this also restricts the amount of food that gets to the stomach. Gastric banding is a reversible surgery as the band can be removed if needed. Comparing to the gastric bypass, however, this option needs longer time to see the effects as the bypass component is not included. The weight patients after gastric bypass surgery lose in a year can only be lost in four-five years after gastric banding operation. On the other hand, however, it is said to be safer and more physiological way of weight-loss.

Another option to lose weight is Biliopancreatic diversion/duodenal switch. Compared with the above it is the least popular method of weight-loss. The reason is that it has the highest mortality (2.5% to 5%). The results. however, can reach 60% to 80% of weight-loss within one year only.

A very important thing to remember is that weight-loss surgery can result in side effects. The most common are: abdominal pain, gas, diarrhea, even nausea and vomiting. This may cause malnutrition and deficiency of vitamins. This again may cause osteoporosis and Wernicke’s Encephalopathy (thiamine deficiency). Other side effects may also be muscle weakness, abnormal eye movement, mental confusion or movement incoordination.

In many cases obesity can be worked against by using the right diet full of fruit, vegetable and protein, as well as being active.

By Kate Devlin Medical Correspondent Daily Telegraph 10/09/08

One of Britain’s top surgeons is considering taking legal action over the “rationing” of life saving obesity surgery on the NHS.Professor John Baxter said that the health service was putting patients lives at risk by not funding the surgery for many.

He accused Primary Care Trusts of limiting the number of operations they performed because of the cost, which can be up to £6,000.

He said that the operations, which include gastric band surgery, would pay for themselves within four years, because they would reduce the number of obesity-related conditions, such as diabetes.

The health service currently carries out fewer than 300 stomach shrinking operations a year.

Professor Baxter said that half of all PCTs in England were ignoring guidelines that morbidly obese patients should have the surgery, which can lead to rapid weight loss.

He told Sky News: “Yes, it is fair to say that I’m considering a legal challenge because that is true. You can’t go further than that as I have just discovered that there’s no legal compulsion to follow NICE guidelines”.

Professor Baxter, the president of the British Obesity Surgery Society, added: “The case for obesity surgery is overwhelming. It is clearly being rationed.

“I am surprised there have not been more law suits by patients around the country, trying to say ‘why are you not providing this’ and it’s just a matter of time I think.”

“You actually save money by investing in obesity surgery. Sure it costs a lot up front. But after three to four years you are saving money,” said Professor Baxter.

“You actually save lives,” he added.

Professor Baxter pointed to other patient groups which used legal action to advance their case for expensive treatments.

These include breast cancer patients who went to court in a battle over the drug Herceptin, which was eventually allowed for the early stages of the disease.

Obesity costs the NHS a estimated £1 billion a year, because of the expense of dealing with related conditions including heart disease and some even forms of cancer.

An estimated 1.2 million people in Britain are now so heavily overweight that they qualify for obesity surgery.

At the current rate at which the NHS performs the operations it would take the health service 54 years to clear the backlog.

Patients who receive the surgery can lose significant amounts of weight and increase their life expectancy, studies have shown.

Last month Alan Johnson, the Health Secretary, warned that today’s obese children faced dying 11 years younger than their slim classmates.

The National Institute for Health and Clinical Excellence (Nice) says that patients are eligible for the surgery if they have a BMI more than 40, and previous attempts at diet or prescriptions of weight-loss drugs have failed.

Anyone with a BMI between 35 and 40 can also be eligible, if they have an obesity-related condition such as diabetes.

But some PCTs require a BMI of more than 50 before they will consider the operation.

By Steve Connor, Science Editor INDEPENDENT (UK)
Tuesday, 9 September 2008
The number of Britons undergoing drastic stomach surgery to treat obesity will have to soar in the coming years because it will be the only way that many people are able to maintain the weight loss necessary for a healthy life, scientists have said.

Dieting and other lifestyle changes can lead to substantial weight loss. But many people, the scientists said, find it hard to maintain the loss because hormone levels change, making the body want to produce more fat.

“Once you start losing weight by decreasing calorie intake, your body interprets this as starvation and goes into emergency status, fighting to lay down fat deposits where possible,” explained Rachel Batterham of University College London. “Therefore you are fighting against your body when losing weight.”

Stomach surgery such as gastric bypass operations should not only be carried out on severely obese people, but offered to overweight men and women as a form of disease prevention, in much the same way statins are offered to prevent heart disease, they said.

At least 10 times as many people who currently have gastric bypass operations on the NHS already qualify for one under the Government’s own guidelines, according to the researchers, who believe that not enough is being done to inform obese patients about the benefits of surgery.

Dr Batterham added: “Surgery is currently the only effective treatment for obesity … It not only helps people lose weight by physically decreasing the amount they can eat, but also alters their hormone profile, meaning they feel less hungry and therefore find it much easier to maintain weight loss.”

An increasing number of men and women will fall in the eligible category for bariatric surgery, where the stomach is stapled or bypassed altogether by diverting food directly to the small intestine, said Carel Le Roux of Imperial College London.

Severely overweight people with a body mass index of 35 already qualify for gastric surgery and studies have shown that although the operation carries a small risk, the long-term benefits are better than for patients treated with drugs or lifestyle changes, Dr Le Roux told the British Association for the Advancement of Science’s Festival of Science at Liverpool University.

“The only proven way to lose weight and live longer is by having obesity surgery,” he said. “This type of surgery will, however, not make you thin, nor will it make you happy, it will only make you healthier.”

He added: “If we have low levels of mortality later on, we should ask ourselves the question, why is this not available to more patients and why in fact do we restrict this to patients with a body mass index over 35?

“Is it fair to restrict another medication like statins? Do we restrict statins to people who have already had heart attacks? No, we give them to people at risk of heart attacks.”

A gastric band operation costs the NHS about £5,500 and a gastric bypass costs about £9,000. At present about one in 100,000 people have the surgery but under the Government’s Nice guidelines, about 10 in 100,000 people actually qualify for the operations.

It was once widely believed that gastric bypass operations work by preventing food absorption in the gut but recent studies have shown that the surgery alters levels of the hormone which controls hunger pangs, said Dr Batterham.

“About one in four people in Britain is obese and this is projected to rise to 60 per cent of men and 50 per cent of women by 2050,” said Dr Batterham. “Future research will focus on developing drugs that work in the same way as gastric surgery in altering the hormone levels that control hunger and feeling full.”

Tenerife News September 2008

Even though a lot of celebrities have gastric band fitted, is not a fashionable accessory. It helps with the weight loss and for many people it’s a lifesaving operation.

The surgery is done under anaesthetic followed by microsurgery where several small incisions are made in the abdomen. Thanks to this the surgeon can operate the camera on the end of instruments to put the band around the stomach. If the client is more obese, a laperotomy takes place. This is a larger incision 15 to 20 cm in the abdomen.

The band is made of silicone, it is inflatable and is put around the upper part of the stomach. It makes the stomach smaller. In practice it means you do not to each much as you feel full quicker.

There are obvious benefits of the surgery but there are side effects of the surgery. Nausea or hair loss are some of them. Gastric banding also means healthy eating for life. The diet afterwards must be low-fat and high-protein. Only thee small meals a day should be eaten and no drinks should be taken during the meal.

Patients must also be aware that some foods (such as bread or pasta) can be tolerated more difficult. The other thing is also not eating the recommended amount of food – no weight will be lost if you still eat that much as you used to.

Not all obese patients qualify for gastric banding. Only those with BMI over 40, type 2 diabetes, with high blood pressure and heart disease are being recommended for such an operation. These conditions improve after the surgery, for example type 2 diabetes can disappear.

To help manage the diet it is possible to regularly meet nutritionists as well as support groups.

Who should be considered? Those who are clinically obese and whose weight is dangerous for health

Yorkshire Evening Post July 22, 2008

Paul Manku is now a happy father of two children but in the past it was not always the case. There was time when he weighted 50 stone and was so ashamed of how he looked that he barely left the house. He even used to buy buggy clothes on the internet.

“I felt awful about being so big. I wouldn’t go out with my children, I avoided social situations and I wouldn’t go to parents evenings. I was ashamed and I didn’t want to embarrass my kids.” Paul said.

He did not even know exactly how much he weighted as many scales could not read his weight.

In the past Paul played a lot of hockey, did kick boxing and went to the gym regularly. Unfortunately, after a car accident in 1993 he had to stop all his activities. As he started eating a lot (even 7.000 calories per day), he put on weight quickly.

Eventually, he booked an appointment with a gastric bypass surgeon and had an operation last September. He lost 16 stone until now but still hopes to lose 14 more. And, as he is saying, this operation has changed his life and now he feels like a “proper family� as he goes out with his children, and took up boxing and swimming again.

“The operation really has changed my life. I’ve still got a lot of weight to lose but I’ve got my confidence back and I’m happy again.” Paul said.

Reuters August 25, 2008

Last researches show that metabolic syndrome that increases the risk of heart disease, stroke and diabetes in obese patients can be treated by gastric bypass surgery.

Dr Fransisco Lopez-Jimenez and his colleagues from Mayo Clinic in Rochester, Minnesota, evaluated patients for the bypass surgery. The patients met at least three out of five criteria such as: low levels of high-density lipoprotein �good� cholesterol, increased blood pressure, high levels of “bad� fat, obesity and high blood sugar levels.

Two groups of patients took part in the research: one of them including 180 patients who had a gastric bypass surgery and the other one (157 patients) who did not. The reasons for that were: they did not have lifestyle interventions during the evaluation, were denied coverage by insurance provider or declined surgery.

Both groups had their BMI (body mass index) checked and it was 49 for the first and 44 for the second group. A normal BMI is between 18.5 and 14.9.

During the usual 3-4 years follow up after the surgery, researches showed that in the group that had the gastric bypass surgery, the metabolic syndrome decreased from 87% to 29%. In the group that did not have the surgery there was a change from 85% to 75%.

When it comes to the weight loss, the surgical group lost 44 lbs in average whereas the non-surgical group – 0.2 lbs.

“Our study provides robust data to practicing clinicians about the benefits of counseling weight reduction in metabolic syndrome patients,” Lopez-Jimenez said. “Gastric bypass surgery should be considered as a treatment option in patients with metabolic syndrome that has not responded to conservative measures” he adds.

Daily Telegraph 05/05/08
The Government’s medical advisory body is recommending radical surgery to help patients and the public purse, writes Lorraine Fraser.

More than one million people who are grossly overweight should be able to have stomach stapling operations on the National Health Service to cure their eating disorders, according to the body that advises the Government on which treatments should be available the NHS.

The National Institute for Clinical Excellence (Nice) has decided that the consequences of being seriously obese are so great for individuals and the public purse that drastic treatment should be offered routinely where all else has failed.

As many as 1.2 million people in Britain are already so heavy that they would qualify for surgery, says the institute, and the number may be increasing by as much as five per cent every year.

This would include 400,000 women and 124,000 men who are classified as “morbidly obese” and a further 600,000 people who are slightly thinner but suffering debilitating side effects such as heart disease, high blood pressure and diabetes.

Only 200 operations a year are currently carried out for obesity, about half of them in the private sector. The surgery, which is classed as a major procedure, involves reducing the size of the stomach or bypassing it altogether in order to restrict the patient’s ability to absorb calories. Nice has suggested a gradual increase in NHS operations, reaching about 4,000 a year by 2010.
The institute has been widely criticised for declining to approve a number of costly cancer drugs, and its decision on obesity has huge implications for NHS resources. It will require a significant increase in the number of specialist centres offering slimming programmes using diet or drugs as a first option, alongside an increase in surgical facilities.

The annual burden on the NHS of treating illnesses caused by Britain’s burgeoning obesity problem is at least £500 million. The indirect costs to the nation from sick leave and premature mortality have been put at £2.1 billion a year.

“There is a pressing need for this,” said Deanne Jade, the principal of the National Centre for Eating Disorders who helped to develop the guidelines.

“There are a lot of people out there with serious problems. We have to make surgery an option, but it will have to be very carefully controlled.”

About 46 per cent of people in Britain are overweight and 21 per cent of adults are clinically obese, defined as a body mass index of 30 or more (calculated as their weight in kilograms divided by the square of their height in metres). A normal BMI is 18.5 to 24.9.

Two per cent are “morbidly obese”, with a BMI over 40. These individuals, in addition to people with a BMI of between 35 and 40 who already have a medical condition such a diabetes, would qualify for surgery under the proposals. Anyone with a BMI of 25-29.9 is “overweight”.

Ian Campbell, the chairman of the National Obesity Forum said: “Common sense would tell you that the way to lose weight is to eat less and be more active, but there is a section of the population for whom it is not enough. In this context, medical intervention is essential.”

Stephen Pollard, a consultant surgeon at St James’ University Hospital in Leeds and a specialist in obesity surgery, said that the operations could provide a permanent solution for patients who had struggled for years.

“The health economic arguments of surgery are very powerful,” he said. The problem, however, would be “finding the time, money and manpower within the NHS”.

Press association 20/02/08

Many obesity units are refusing obesity surgery for patients on the grounds of cost, a survey has shown.

The study found that hospitals and primary care trusts have seen a 650% rise in referrals for surgery from doctors over the past five years.

Six out of 10 consultants approached at 20 hospital trusts across England said they were not sufficiently resourced to cope with the huge rise in demand.

The survey of 20 specialist obesity units was carried out by Pulse magazine. Half (52%) of consultants said their units were forced to bounce referrals back to GPs after refusing surgery for patients.

The study also found that one in five trusts capped the number of referrals they allowed obesity specialists to see due to financial constraints.

Dr David Haslam, clinical director of the National Obesity Forum and a Hertfordshire GP, told Pulse he believed the move was a “completely false economy”.

He added: “To limit it on the grounds of cost is disgraceful. Some PCTs refuse altogether while others take 10 or 20 procedures and no more. People will be dropping down dead because of it.”

Professor John Baxter, president of the British Obesity Surgery Society, said provision in Wales, where he worked at the Morriston Hospital in Swansea, was “among the worst in the country”. He added: “To say there’s underfunding is a massive understatement. It’s appalling. There should be a public inquiry in my view.”

A Department of Health spokesman said: “In our recent obesity strategy we announced increased funding over the next three years to support the commissioning of more weight management services in the NHS, where people can access personalised services to support them in achieving real and sustained weight loss.

“It is up to PCTs as local commissioners and providers of services to determine the most appropriate methods to deliver health care to their populations, based on clinical need and effectiveness, and following medical advice. There is an increased risk of complications during bariatric surgery, given that there are existing medical conditions in obese patients so operations are not always the best option.”
COSMETIC BLISS COMMENT
We are saddened but not surprised by the story. Obesity is an illness, NOT a lifestyle choice, contrary to the beliefs of some. We do wonder if the attitude of “it’s your own fault you are obese” prevails in the minds of some of those responsible for allocating resources within the PCTs. Long term, surgical solutions would actually SAVE the NHS money in terms of the extra costs associated with treating obesity-related illnesses.
Cosmetic Bliss provides safe bariatric surgery outside the UK (incidentally at less than half the £10,000 minimum it apparently costs the NHS)
We are able to flourish as a company because of the appalling lack of provision for bariatric surgery within the NHS – to which we ALL (including the obese) contribute. We will continue to offer the highest quality Bariatric Surgery and our unique personal support and assistance through the surgical procedure and afterwards to our patients – providing a much needed safe & affordable option to those who cannot afford to wait for surgery on the NHS, and who are reluctant to pay the high prices charged for private treatment in the UK.

20 February 2008 Swansea Evening Post
Obesity services in Wales are among the worst in the country, a Swansea surgeon has claimed. Professor John Baxter was responding to a study which has found many obesity units are refusing surgery for patients on the grounds of cost.

The study found that hospitals and primary care trusts had seen a 650 per cent rise in patients being referred for surgery over the past five years.

Six out of 10 consultants approached at 20 hospital trusts across England said they were not given the resources to cope with the huge rise in demand.

Half (52 per cent) of the consultants said they were forced to bounce patients back to their GPs after refusing surgery.

Morriston Hospital-based Mr Baxter, president of the British Obesity Surgery Society, said: “To say there’s under-funding is a massive understatement. It’s appalling. There should be a public inquiry in my view.”

The survey of 20 specialist obesity units was carried out by Pulse magazine, a publication for doctors.

Dr David Haslam, clinical director of the National Obesity Forum and a Hertfordshire GP, told Pulse he believed the move was a “completely false economy” and “people would be dropping down dead because of it”.

He added: “To limit it on the grounds of cost is disgraceful. Some PCTs refuse altogether while others take 10 or 20 procedures and no more.”

A Department of Health spokesman said funding would be increased over the next three years “to support the commissioning of more weight management services in the NHS, where people can access personalised services to support them in achieving real and sustained weight loss.

“It is up to PCTs as local commissioners and providers of services to determine the most appropriate methods to deliver healthcare to their populations”.

He added: “There is an increased risk of complications during bariatric (obesity) surgery, given that there are existing medical conditions in obese patients, so operations are not always the best option.”

One of those waiting for surgery is Jemma Butler, aged 24, of Neath Road Plasmarl.

She has been refused surgery to remove most of her stomach so she can trim her 33 stone weight, because doctors have said she is not ill enough for the £10,000-£20,000 opearation to take place on the NHS.

She said this month: “I’m a 24-year-old, but I’m living like I’m a 70-year-old.

“All right, I haven’t got diabetes, and I haven’t got heart disease now, but who’s to say in a couple of years’ time that I could have it if I don’t have this operation?”
COSMETIC BLISS COMMENT
We are saddened but not surprised by the story. Obesity is an illness, NOT a lifestyle choice, contrary to the beliefs of some. We do wonder if the attitude of “it’s your own fault you are obese” prevails in the minds of some of those responsible for allocating resources within the PCTs. Long term, surgical solutions would actually SAVE the NHS money in terms of the extra costs associated with treating obesity-related illnesses.
Poor Jemma Butler is in a no-win situation – she is young enough not to have developed any of the diseases associated with obesity – and so cannot qualify for surgery, yet, according to the quote from the Health Department spokesman if she were to develop these conditions surgery might be considered “not the best option”. Cosmetic Bliss provides safe bariatric surgery outside the UK (incidentally at less than half the £10,000 minimum it apparently costs the NHS)
We are able to flourish as a company because of the appalling lack of provision for bariatric surgery within the NHS – to which we ALL (including the obese) contribute. We will continue to offer the highest quality Bariatric Surgery and our unique personal support and assistance through the surgical procedure and afterwards to our patients – providing a much needed safe & affordable option to those who cannot afford to wait for surgery on the NHS, and who are reluctant to pay the high prices charged for private treatment in the UK.