A radical new approach to Weight Loss Management

Nicholas Rudd-Jones talked to Mr Alfred Choy MA MB BChir FRCS and Mr Andrew Kemp RGN, MSc, DMS the CEO of Gateway and president of the National Institute of Obesity Programme Practice Standards (NIOPPS) to understand the Fitzwilliam's radical new ‘Gateway pathway' to weight management which is based around the belief that continuing weight management support is a vital part of a successful long-term outcome

The problem of obesity
Obesity is an increasing problem in our society with the ready availability of fatty foods and a more sedate lifestyle. And obesity, if untreated, can lead to various medical problems including heart disease, respiratory problems and diabetes, all leading to reduced life expectancy. Obesity is calculated by the Body Mass Index (BMI):. 20-25 is normal, 30 or more is obese and 40 and above is morbidly obese.

Weight management
The first step in losing weight is to diet and take more exercise, but normally a diet leads to fairly modest and temporary reductions in weight, typically 5-10%. Likewise, there are drug treatments that can lead to a similar reduction in weight.

Gastric banding, which is the insertion of a restricting band around the stomach that limits what a patient can eat, so they lose weight, can have a much more profound impact on body weight, typically reducing the body weight by 30-70%. The National Institute for Clinical Excellence (NICE) guidelines indicate that you are eligible for the treatment if you have a BMI higher than

40 or 35 if you have an additional condition such as diabetes or asthma. The procedure itself is done by keyhole surgery and the operation itself takes about an hour. Including preparation and recovery time, you are likely to be in hospital for two days.

Ballooning, which does not require an anaesthetic and is a totally reversible process, works by inserting a ‘balloon' within the

stomach to reduce hunger; it can likewise lead to significant weight reductions and may be a good solution in certain circumstances. The Gastric balloon procedure is a non surgical procedure, the balloon remains in the stomach

for 6 months. It is an effective solution for some patients from BMI 27. The balloon reduces hunger and allows the patient to make lifestyle changes with the help of the Gateway Lifestyle Programme.

The Gateway pathway
The Fitzwilliam has observed that, whilst a surgical intervention may be the best way to lose weight, its effectiveness is sharply improved by working together with the patient from the start of the process through to 12 months and more after, to ensure that the right weight management habits are formed and then maintained. In the words of Andy Kemp, who runs the Gateway pathway, “continuing support is a vital part of the process”. Without this support, there is a danger that a patient might ‘cheat' the weight loss device and start to put on weight again at a later date.

How does the Gateway pathway work?
The Gateway pathway, in a nutshell, brings all aspects of care together – the quality caring environment of the Fitzwilliam Hospital, the clinical excellence of the consultants and the Gateway pathway methodology that manages the patient's progress throughout the process.

The Gatewayhealth ‘pathway falls into five broad steps:

Step 1
The patient can approach the Fitzwilliam through a GP referral or directly. They will meet with a qualified nurse and complete a detailed questionnaire so that the hospital can fully understand the behavioural and physical issues around their situation.

Step 2
If appropriate, the patient will then be referred to Mr Choy, the consultant in charge. He will assess the individual's case and determine whether surgery is the most appropriate route, and if so whether that should be gastric banding or ballooning.

Step 3
The patient is prepared for surgery by a specialist nurse and a consultant anaesthetist. After a gastric banding operation they will usually stay overnight and leave the next day.

Step 4
The patient is contacted daily for the next two weeks by a named specialist nurse to ensure that everything is progressing smoothly and that good weight management habits are becoming established. The patient is called for the first few days and longer as necessary, the patient has a direct contact number for their nurse and is seen in clinic at week one. There may be a return to the hospital clinic after a couple of weeks for the band adjustments as required.

Step 5
It is reckoned that new habits typically take three months to form. This is vital to ensuring on-going weight loss and the named contact will continue to provide support to the patient to help them to become self-sufficient in any social.

In summary, the Gateway pathway brings together a team of professionals who act seamlessly throughout the process, bringing all aspects of the care together, to produce the best possible outcome for the patient. And critically the patient remains the main focus throughout the process

The consultant at the Fitzwilliam
Mr Choy is a Consultant Physician in General Surgery at the Fitzwilliam. He trained in Cambridge, Liverpool and London. About fiveyears ago he went to Brussels to gain specific expertise in gastric banding, and he is a member of the British Obesity Surgery Society (BOSS). He is supported by a second specialist, Mr Bajwa. Mr Kemp leads the Gateway pathway ensuring that the overall process is optimised, and supplying the pre- and post-op support.

Next steps
Call Gatewayhealth on 0845 9000 339