Obesity and your health

The most common misconception about weightloss surgery is that it is all about body image and wanting to look good. However, while anxiety and embarrassment are often contributing factors in the decision to have weightloss surgery, the overwhelming majority of our patients take the decision either because of an existing medical condition related to their weight or because they are worried about their future health.

Obesity has many health related risks or ‘co-morbidities’. Weight loss surgery can reduce the risks these problems cause and can in some cases permanently eradicate the problems altogether. A surgical solution to weight loss can sometimes seem like a big step, but the health benefits of losing weight are significant; increased life expectancy and an overall improvement in patient’s quality of life.

The statistics featured in the following information (unless otherwise stated) all relate to studies conducted by Paul O’Brien MD, one of the world’s leading experts on gastric banding. These figures and studies are all referenced in his definitive book The Lap-Band Solution, published by Melbourne University Press.

Asthma

Asthma is 50% more common in overweight individuals than those of normal weight. Obese patients are more likely to suffer asthma attacks as a result of their weight and the affect it has on their lifestyle.

STUDY – Melbourne Monash University – Paul O’Brien MD:

33 patients were followed for 1 year after LAP BAND placement. All patients showed improvement with less attacks and easier to control symptoms. 33% had no asthma attacks at all during the 12 month period. In the year previous to the Gastric band placement, 9 of the group had been admitted to hospital on one or more occasions due to acute asthmatic episodes. No admissions were necessary in the year following the operation.

Diabetes

In most cases type-2 diabetes exists because of obesity and in most cases will disappear with weight loss.

Research shows that the risk of developing type-2 diabetes was 5 times greater at BMI 25 than at BMI 21, 35 times greater at BMI 30 and 93 times greater at BMI 35 and above.

Most patients that are diabetic prior to LAP BAND surgery either become non diabetic or have a significant reduction in their diabetic medication.

Epidemiological studies have demonstrated that diabetes is an independent risk factor for cardio-vascular disease (heart disease), and that it amplifies the effects of other common risk factors such as smoking, hypertension and hypercholesterolemia (high cholesterol).
[For further information visit www.nature.com/clinicalpractice/endmet and search ncpendmet1066]

A 15 year study recently concluded in Japan has shown that diabetes patients were 74% more likely to develop dementia than non-diabetes patients. Further research across a wider demographic has yet to be concluded, but the evidence in this study strongly supports available research into the impact of diabetes and impaired glucose tolerance on the development of any type of dementia and Alzheimer’s.
[Ohara T, et al “Glucose tolerance status and risk of dementia in the community: The Hisayama Study” Neurology 2011; 77: 1126–1134]

STUDY – Melbourne Monash University – Paul O’Brien et al

50 patients were studied who had diabetes and severe obesity. At 1 year post LAP BAND placement 28 (56%) were off all treatment and had normal blood sugar and other markers of diabetes. To all intents and purposes they were cured. A further 14 patients were much improved but still needed some treatment. Thus a total of 84% had a complete or partial benefit.

No other treatment other than weight loss can have such a powerful effect on diabetes. Most treatments strive just to limit the severity and dangers of the disease by keeping the blood sugars as near to normal as possible. Weight loss can take the disease away completely. Diabetes damages most systems of the body and can severely shorten life expectancy. If you are obese and have type 2 diabetes it is essential that you lose weight. If the simpler options of lifestyle change through eating less and exercising more have not succeeded, then weight loss surgery should be considered.

Dyslipidemia (abnormal fats in the blood):

In obese people the triglyceride levels are often elevated and the high density lipoprotein (HDL) cholesterol, which is sometimes referred to as ‘good’ cholesterol is abnormally low.

Obese patients with type-2 diabetes have a higher risk of developing dyslipidemia, where it is one of the major risk factors for cardio-vascular disease (heart disease).
[For further information visit www.nature.com/clinicalpractice/endmet and search for ncpendmet1066]

Study – Melbourne Monash University – Paul O’Brien MD et al

Several hundred patients were followed for 4 years post LAP BAND placement. It was found that the triglyceride and HDL cholesterol levels rapidly return to normal and stay there for at least the 4 years. As abnormalities of these lipid levels is a less clear risk factor for heart disease, this reduction is considered as very beneficial.

Hypertension (high blood pressure)

High blood pressure is a major risk factor for heart attacks and strokes; this is much more common in the obese.

STUDY – Melbourne Monash University – Paul O’Brien MD et al.

88 people with high blood pressure were followed for 12 months post LAP BAND placement. At 12 months it was found that 60% had returned to normal blood pressure and were off all treatment. Another 33% had found that their blood pressure was much easier to control.

Non – Alcoholic Steatohepatitis (NASH)

NASH means inflammation of the liver which is NOT due to excess alcohol consumption. NASH occurs particularly in overweight individuals, who carry their excess weight around the midriff. These people are also at risk of diabetes. NASH is becoming recognised as a major health problem and is now one of the common diseases leading to the need for a liver transplant.

STUDY – Melbourne Monash University – Paul O’Brien MD:

36 patients had liver biopsy at the time of LAP BAND placement and biopsy repeated at 2 years post surgery. NASH was present at the initial biopsy in 23 patients but was present in only 4 patients at the repeat biopsy. The changes associated with weight loss had led to resolution of this dangerous condition in 19 of the 23 people.

Depression

Depression is common amongst obese individuals, due to low self esteem, reduced self confidence plus many more factors.

STUDY – Melbourne Monash University – Paul O’Brien MD et al.:

The level of depression was measured in 262 obese patients, pre-LAP BAND placement. Patients were found to fall almost equally divided into four groups.

25% were not depressed at all.
25% had mild depression.
25% had moderate depression.
25% had severe depression.

These patients were followed for 4 years; a major and durable improvement was noticed. At the end of the study 3 out of 4 were judged not to be depressed and very few were left with moderate or severe depression.

Infertility and polycystic ovary syndrome

Obesity can lead to infertility most commonly due to irregular ovulation or no ovulation at all. One particular common condition in obese women is polycystic ovary syndrome (PCOS). In PCOS there are abnormalities that lead to an excess of the male hormone testosterone in the system. Ladies can develop acne; irregular periods and can have excess facial hair. Weight loss leads to correction of the hormonal problems, periods become more regular and fertility increases.

STUDY – Melbourne Monash University – Paul O’Brien MD et al.:

In a study of the hormonal changes in 107 obese women, 12 were shown to have PCOS initially. This resolved in 11 of the 12 as they lost weight post LAP BAND placement.

Reflux oesophagitis

This problem is sometimes referred to as GERD (gastroesophageal reflux disease.) This is very common in the obese. More than 50% of obese patients have some heartburn. About 1 in 5 obese patients have this severely enough to have to take drug therapy to reduce the acid. 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 pre malignant. It carries a 50 times increase in th chance of developing cancer of the oesophagus.

More than 50% of obese patients have heartburn; almost all are cured post LAP BAND placement.

STUDY – Melbourne Monash University – Paul O’Brien MD et al.

88 patients who had a moderate or severe stage of GERD were followed for 12 months. At 12 months 90% had no further symptoms and were no longer taking medication.

The LAP BAND is good at blocking reflux. This is a direct effect of the band sitting at the very top of the stomach, where it can stop the acid moving up into the oesophagus. The benefit is felt immediately after surgery, even before any weight loss has had time to occur.

Sleep disordered breathing

The most significant disorder of breathing while asleep is Sleep Apnoea. Other problems include: habitual snoring, daytime sleepiness and poor sleep quality.

STUDY – Melbourne Monash University – Paul O’Brien MD et al.

313 obese patients prior to LAP BAND placement were found to have some form of disordered sleep (59% of men and 45% of women).

123 patients were studied at 1 year, the habitual snoring had decreased from 82% to 14%, abnormal daytime sleepiness was reduced from 40% to 4% and poor sleep quality was reduced from 40% to 2%. As a group they were snoring less, sleeping better and felt less tired throughout the day.

Obstructive sleep apnoea

Obstructive sleep apnoea is a disease in which you stop breathing during your sleep. The tissues in the neck have become too bulky and there is in-adequate space. As you start to go into the deep phase of sleep, your muscles relax and your tongue falls back and closes the small space present, blocking the airway. As the oxygen levels in the body fall, the brain stirs, wakes you up and tells you to get back to some serious breathing. You wake up; get some tone back in the tongue, the airway opens and the snoring restarts. These episodes can occur up to 100 times during the night.

It was found that one third of obese patients had symptoms of sleep apnoea prior to LAP BAND surgery. After weight loss only 2% of patients had the problem.

Patients with obstructive sleep apnoea and Type-2 diabetes have a greater risk of developing circulatory problems which can lead to loss of sensation in the hands and in severe cases gangrene and amputation. Weight loss surgery as a treatment for sleep apnoea may reduce or even remove these risks.
[For further information visit www.obesityjournal.org and search for oby2010116a]

Vomiting and the gastric band

With a gastric band there really should be no vomiting. A band is designed to place a gentle restriction on your eating. The band should be an enhancement to your life not a hindrance to your quality of life.

Your aftercare should involve safe and gradual band adjustments (band fills) alongside support and education, behaviour modification, support with emotional eating, nutritional and safe exercise advice. All these are all vital components of an aftercare programme which ultimately lead to the best possible weight loss
If you find yourself vomiting with a gastric band, then your band could be too tight or you could not be following the ‘ Golden Rules.’ it is important to avoid vomiting as much as possible as frequent vomiting can lead to band slippage.

However, you are at risk of having vomiting, just as anyone else might, from food poisoning, gastroenteritis, pregnancy etc. First of all avoid drinking contaminated water when travelling abroad. Gateway Health advise patents to have the fluid removed from the band prior to travelling to less developed countries. On return from their trip the fluid is re-added.

We advise our patients to obtain an anti-emetic (anti-sickness) that dissolves in the mouth. If our patients develop a vomiting illness which is not resolved by taking an anti-emetic (anti-sickness) we seek to remove the fluid quickly. We will refill the fluid once the patient is fully recovered.

Excessive vomiting creates swelling of the stomach tissue inside the band, making it tighter. The swelling perpetuates the vomiting. Removing the fluid breaks the cycle.