Obesity is now a worldwide epidemic.

The World Health Organisation reports that more than 1 billion people worldwide are overweight and at least 300 million of them are severely overweight or obese. An estimated 115 million of these people will develop serious medical conditions including:

~ Type 2 diabetes
~ Heart disease
~ High blood pressure (hypertension)
~ Cancer
~ Stroke
~ Sleep apnoea
~ Respiratory problems
~ Osteoarthritis
~ Joint problems

Many doctors now believe that obesity could be more harmful to health than alcohol or smoking. The good news is that studies show that these potentially life threatening conditions can be improved with weight loss. Read more>>

Obesity is not a sign that an individual is out of control, there are many causes of this chronic problem, including:

Energy balance – taking too much energy from food that is in excess of what the body needs can lead to weight gain, depending on individual metabolism and activity.

Heredity – if other members of your family are obese, you may have a higher risk for obesity.

Metabolic disorders – changes in metabolism, or how your body gets its energy from food, may affect your energy balance and your weight.

Eating and social habits – eating an unbalanced diet, snacking between meals and not getting enough exercise may all contribute to obesity.

Psychological factors – social or emotional eating is one of the main causes of gaining excess weight.

Any one or a combination of these factors can lead to obesity and it is therefore important that individuals who want to reduce and control their weight understand the treatment options available to them. Read more >>

To hear more facts about the problem of obesity and the options for reducing and controlling weight, come along to one of our weight loss clinics.

More about Obesity

After millions of years of evolution we carry a genetic structure designed to enable us to survive the life of the hunter-gatherer, but our health and our lives are now threatened by a lifestyle characterised by ready access to copious amounts of attractive food and very little need for physical activity. Foods high in fat, carbohydrates and, in particular, simple sugars, are booming. In the USA the Department of agriculture reports that the per capita intake of sugar was 152.4lb (69kg) in 2000. This equates to nearly ½ lb of sugar per day per person. One hundred years ago, the sugar intake per capita was only 0.5lb (230g).

Most people will claim they are not eating that much sugar. However, sugar is now a part of so many foods that we don’t realise we are eating it. Sugar has infiltrated our diet to a frightening extent.

BMI

BMI is the most commonly used measure of obesity. We need a measure that is simple to make and is acceptably accurate. Direct measure of amount of fat in a body is not simple and measuring weight alone is not accurate enough. Across the world BMI is accepted as the best primary measure because, in most situations, it provides an accurate reflection of the amount of fat present. As weight increases, it mainly as fat, there may be some increase in muscle as well, but it is usually a small proportion. As you loose weight, the loss of fat is predominant, but you may also loose some muscle mass.

We have now established what we consider to be normal values for the BMI scales, these are for western population, there are small adjustments needed for Asian/ African etc. We know that the cut off for the so called western world is BMI 30 to be obese. For Chinese, Indian and Malay populations, BMI 27-28 should be regarded as obese, as they have a higher proportion of fat at those BMI points.

Another point to make is that an athlete, who builds up muscle through heavy training can put on weight without additional fat. BMI measures in this group will not reflect the fat content of the body.

BMI also doesn’t tell us anything about the distribution of fat. We recognise that those with central obesity – the large belly area, have a higher risk of a range of obesity related disorders, such as heart disease and diabetes, compared with those with peripheral obesity – large bottom and legs. In other words, the “apple” shape is worse than the “pear” shape.

In adolescents BMI alone is not enough, we must also include the age and look at growth charts to see if the child is outside the expected range. Fat measurements are most accurate in this group.

Any level of obesity is bad for you. At BMI 30 you are at a higher risk of diseases and have a reduced life expectancy. For life expectancy alone if your BMI is greater than 35, you are in a high risk group and by the time you reach BMI 40, the risk is nearly 3 times that of people who have normal weight. The risk rises very steeply as your weight goes above BMI of 40.

It is important to note that BMI is not a perfect measure. It is used as a surrogate for amount of fat. Its great advantage is that it is simple to use as an indicator for further observation.

There are many other ways of measures obesity. These include DEXA, which stands for dual energy X-Ray absorptiometry. It is complex and the machines are very expensive and slow to use, but very accurate. Underwater weighing. It provides a measure of weight per unit volume. Although accurate, it is useful in research studies, it is not really an acceptable way of measuring for most people. Bioimpedence, which measures the resistance of a small electrical current through the body. Fat impedes the flow through the body more than other tissues. From the measurement of impedances against weight and height, the machine calculates the amount of body fat.

The Centre for disease control in Atlanta , Georgia , estimated that, depending on how you calculate, the numbers, there were between 112,000 and 380,000 excess deaths from obesity related disease in the USA during the year 2000. Whichever figure is correct, or something in between, it is an horrific statistic. Teenagers entering adulthood with a BMI in excess of 40 would have their life expectancy reduced by up to 13 years for a male and 8 years for a female. The risk of early death from obesity is similar to that of smoking.

The disease

A Pathogen is something that causes disease. Obesity is the consummate pathogen. It causes or makes worse a broad range of diseases, such as type 2 diabetes, coronary heart disease, hypertension, stroke, sleep apnoea, depression, a range of cancers including breast cancer. Gynaecological, and gastrointestinal malignancies, abnormal levels of fats in the blood, polycystic ovary syndrome, inflammation of the liver, and osteoarthritis of the lower spine and weight bearing joints, such as hips knees and ankles.

Illnesses caused by or exacerbated by obesity

• Diabetes
• Low back pain
• Hypertension
• Infertility
• Dyslipidaemia Polycystic ovary syndrome
• Ischaemic heart disease Deep vein thrombosis –DVT
• Cardiomyopathy Thromboembolism
• Pulmonary hypertension
• Depression
• Asthma
• Immobility
• Hypoventilation syndromes
• Breast cancer
• Gallstones
• Gastrointestinal cancer
• Obstructive Sleep Apnoea
• Prostate cancer
• Non Alcoholic Steatohepatitis
• Endometrial cancer
• Urinary incontinence
• Venus stasis ulcers
• Gastro oesophageal reflux
• Intertigo
• Osteoarthritis

Disease / problem summary

Obesity is a true problem. It is the worst cause of disease in the western world. It leads to early death in more people than almost any other cause. What life an obese person has is severely reduced in quality because of the physical and social problems generated by the disease. If loosing weight solves even some of these problems, and if we can find an acceptable way to loose weight we should really go for it.

Most people with type 2 diabetes are over weight and about ½ are obese. This is particularly well illustrated by the “Nurses Health Study”, an important ongoing study in the USA , in which approximately 100,000 nurses have been followed for many years. Based on the risk of developing type 2 diabetes when the BMI is 21, this study showed that the risk of developing type 2 diabetes was 5 times greater at BMI 25, 35 times greater at BMI 30, and 93 times greater at BMI greater than 35.

Hyper tension or high blood pressure is a major risk factor for heart attacks and strokes. It is much more common in the obese.

Abnormal fats in the blood is called dyslipidaemia. Dys – means disordered, lipid – is another word for fats, and aemia – is another word for blood. In obese people the triglyceride (a type of fat) levels are often elevated and the high density lipoprotein (HDL) cholesterol, which is sometimes referred to as the “good” cholesterol, is abnormally low.

Reflux oesophagitis or acid reflux, is very common in obese people. More than half the people with severe obesity, seen in some clinics suffer from this with related heartburn. This is the pain or uncomfortable feeling you get behind the breastbone when acid from the stomach travels up the oesophagus and irritates the lining. About one in five patients in some studies have taken some form of drug therapy to reduce acid in the stomach. If the disease continues for long enough, a change, known as Barrett’s oesophagus, can occur in the lining of the oesophagus. This new lining is regarded as premalignant. It carries a 50 times increase in the chance of developing cancer of the oesophagus.

Sleep disordered breathing is as common in women as in men. It can cause snoring, day time sleepiness and results in a poor quality of sleep. A more significant sleep disorder is know as obstructive sleep apnoea (OSA). This is a disease in which you stop breathing during your sleep. The word apnoea means no breathing. Typically, you are snoring away as usual followed by a period of quiet.. There may be silence for up to a minute. Then, after lots of grunts and snorts, you get back to snoring again. What has happened is the muscles in the neck have relaxed and the tissues in the neck have become too bulky, so there is inadequate space. As you start to go deeper into sleep, the tongue falls back closing off the small space left, blocking your airway. As the oxygen level in the blood falls, your brain stirs, wakes you up slightly and you breath again. You wake up a little, get some tone back in the muscles, and the airway opens again. In some studies these episodes can happen more than 100 times in one night. You can not get a good nights sleep under these circumstances.

Asthma has only recently been recognised as an important illness associated with obesity. It is at least twice as common in obese children and adults as those with normal weight. Asthma is a disease that affects the linings of the airway down into the lungs. Patients have most problem breathing out as the airways try to close after breathing in. In some cases this can be very dangerous, it is to say the least frightening.

Non Alcoholic Steatohepatitis (NASH) simply means inflammation of the liver associated with fat and not due to alcohol consumption – NASH is easier to say and use. NASH occurs particularly in obese people who have a lot of weight around their abdomen (apple shaped) and who are at risk of diabetes or who already have diabetes. This is now becoming recognised as a major health problem and is now one of the common diseases leading to the need for a Liver transplant.

Infertility and polycystic ovary syndrome (PCOS) is common in obese women. In this condition which leads to infertility, there are abnormalities that lead to an excess of male hormone, testosterone, in the circulation. Many of these women notice acne and excess hair on the face in association with very irregular periods. Weight loss leads to correction of the hormonal problems, so that periods become more regular and fertility increases.

Not only are women more likely to become pregnant after loosing weight, they will also have a better outcome. Pregnancy in severely obese women is associated with important risks to both the mother and baby.

Quotes

There is no other treatment that can make such a difference to so many people and their heath problems. There is no other therapy which improves quality of life so much. In particular there is no other therapy that so clearly protects people from dying.

Type 2 diabetes is a paradigm of an obesity related disease. In most cases, it exists because of obesity and in most cases, it will disappear with weight loss. It is common, it generates multiple other serious complications and can be lethal.

Always begin with the simple and safe procedures, and then move to the more complex and higher risk if they don’t work for you.

There is no particular value in short-term weight loss. In fact it may even be harmful. Losing even substantial amounts of weight is not particularly difficult to achieve. The real challenge is to keep it off for a long time. We therefore should not only look at the amount of weight loss a treatment can achieve, but also evidence that the weight loss lasts.

Outcomes of significant weight loss research articles

After a gastric band placement

50 patients who had type 2 diabetes and severe obesity were followed for 1 year. 28 - 56% were off all treatment and had normal blood sugar levels. A further 14 – 27% were much improved but still needed some treatment.

Several hundred patients were followed for 4 years after placement and were found to have normal triglyceride and HDL levels. These rapidly returned to normal and stayed there for at least 4 years. As abnormailites of these are a clear risk factor for heart disease, this reduction canbe regarded as beneficial.

88 patients with high blood pressure were followed for 1 year after placement. 60 % had returned to normal and were off all treatment, another 33% found their BP much easier to control.

88 patients who had moderate to severe reflux were followed for 1 year. 90% had no further symptoms and weren’t taking any medication.

In a specific study on weight loss and asthma, 33 patients were followed for 1 year. All showed an improvement with less attacks and the attacks were easier to control. 33% had no asthma attacks at all. Prior to placement, 9 of the group had required more than one hospital admission because of acute asthma episodes.

In a study of the hormonal changes in 107 obese women, 12 were shown to have polycystic ovary syndrome. This resolved in 11 of the 12 as they lost weight.

In a study over 4 years in 262 patients, ¾ were divided into almost equal quarters of mild moderate and severe depression. After 4 years of weight loss ¾ had no depression and very few had moderate or severe depression.

Prevention of obesity

Primary prevention – Avoiding obesity occurring.

Secondary prevention – Avoiding the diseases related to obesity occurring.

Unfortunately we are not very good at primary prevention. We have no successful programmes we can apply across our communities. There are lots of good ideas and theories etc. There have even been pilot studies that may show promise. It is not surprising considering the way we live, with powerful commercial forces that promote over eating poor quality foods combined with inactivity. Not only is the problem of obesity still a problem, it is in fact getting worse. The numbers of sufferers is increasing.

We are no better at secondary prevention. We can treat some of the symptoms and help to control them, but we can’t stop their development. You still have the disease and the medicines are just reducing some of the harmful effects, but they are not curing it. Most of the obesity related diseases are either cured or markedly improved by achieving weight loss.

Gastric Band patient information

It is important that we all see the use of the gastric band in weight loss not just as an operation but as a process of care by a team which commences before the gastric band is placed and continues afterwards.

There must be a partnership between yourself and the team. Success will only occur if both partners contribute. The team must fulfil their role, by placing the band correctly, expert follow up and advice must be given in a way that you can understand. You in turn must be committed to following the rules regarding eating, exercise and activity, and keep in contact with the team looking after you.

You should not consider having a gastric band procedure unless you are totally committed to fulfilling your part of the partnership.

You will be given a separate diet sheet which has rules for eating post procedure. The essence of these rules are;

A maximum of 3 small good quality meals per day.

No snacks between meals.

Each meal has to be solid food.

There should be minimal liquid calories per day, from tea coffee and mineral water etc.

You must eat foods that have good protein content, such as meats, egg dishes, fish, beans and lentils and food that have a high fibre content, such as breakfast cereals, fruit and vegetables.

Limit foods that are high in fat and simple sugars.

Most importantly you learn to eat slowly and a very small volume of food at each meal.

You must also learn to increase your energy output. There must be an increase in activities such as walking and swimming.

The primary focus of the gastric band effect is on the amount of weight that is lost. We expect that on average people who have the procedure will loose between ½ and 2/3 of their excess weight in 1 – 2 years post procedure. This is an average, and it will depend on the individual, some more and some less. Because we have control over the gastric restriction, we have the confidence that we can achieve more weight loss with out interfering with the quality of life. We don’t want to have a severe restriction on normal living patterns.

• Weight loss Surgery
• Gastric Band
• Gastric Balloon
• Weight loss Programme
  

Call 0845 9000 339 to book your place or for more information.