Rise in obesity sees 20 people a month go under the knife for life-saving surgery

People in Nottingham are twice as likely to be admitted to hospital with obesity related problems – higher than anywhere else in England.

One city clinic has also revealed that around 20 overweight patients a month are opting to have weight-loss surgery which can include having three-quarters of their stomach removed.

But Nottingham nutrition coach Susan Hart says gastric surgery should be “a last resort”.

Recent statistics show that obesity-related admissions are up by a third in the last year.

Gastric Sleeve surgery Nottingham

Private clinic Gateway Health says there has been a significant increase in the last year of people wanting gastric surgery – seeing 20 clients a month, 17 of whom will be suitable for treatment.

Surgery includes fitting gastric bands, which restricts the amount of food the stomach can hold by placing an inflatable silicone band around the upper part of the organ and gastric sleeves, which removes a large portion of the stomach.

Andrew Kemp, chief executive of the clinic, told the Post: “We have seen a significant increase since the middle of last year and we are not marketing or doing anything different than before.

“I wish I did know why. The trend across the country is pretty flat but in our area it seems to be more prolific.

He predicts that instead of being used as treatment, such surgery will become preventative. “Ten to fifteen years from now we will be doing gastric bands to stop people from gaining massive amounts of weight.

“We can see there is a significant benefit for them, why wait till people are really sick to have them. It is a bit like a smoker with a nicotine patch. It does not stop you smoking but it takes away the craving.

“The gastric band will help take away some of those cravings for food.”

He said the private clinic used to see on average 10 patients a month, but that had now doubled. The surgery is usually undertaken on someone who has a body mass index (BMI) of 35 and over.

Mr Kemp believes the food we eat has not become any fatter, but that people are exercising less than they did in the 1950s.

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Steve and Rachel from Sheffield

Hi, my name is Steve. I’m a patient at Gateway. And I’m going to make my target. Absolutely fantastic!
Care at this place was brilliant, I couldn’t fault it at all.
I know my wife Rachel next to me, she wants to come in so I recommend my wife. She’s still going, losing weight. Absolutely fantastic and I’ve lost about ten stone now, nearly two year, absolutely amazing. Changed my life completely, love it.

Hello my name is Rachel, I was recommended to gateway from my husband who was recommended by a friend of the family who had fantastic results. I’ve had the surgery just over a year and lost five stone. So I’m hoping that in the next year I’ll lose another five stone to get to the same weight as my husband, which is a ten stone loss.

The staff have been great and nothing’s too much trouble and I would recommend Gateway Health.

Testimonial Video – Jo Walker

Hello. My name’s Jo Walker and I just want to tell you briefly why I came to Gateway. I explored for a long time other options of weight loss. I explored other providers of weight loss procedures. And because I explored it, I knew that Gateway was the right one. The service, the attitude, and success is beyond comprehension to me.

Gateway gave me my life back, they gave my husband his wife back, and more than anything, they made me so happy. The aftercare, the telephone calls, the total communication is second to none. I can’t thank Gateway enough. I really, really can’t. And I would recommend them to anybody. Thank you Gateway.

Sarah from Peterborough

Hello. My name’s Sarah. I’m a hairdresser from Peterborough. I had a gastric band 10 months ago and I’ve lost 6 and a half stones so far. I chose Gateway Health for the aftercare because it was close to home at the Fitzwilliam Hospital. I had my gastric band ten months ago. I’ve lost six and a half stone so far.

I’m really, really pleased with the results. It’s changed my life completely. From assessment to surgery to the after care it’s all be very friendly, helpful, and professional. Whenever I phoned up there’s been someone there trying to to talk to me or help me when I’ve had a few problems or queries.

I would recommend them highly.

Gateway Health welcomes the findings of the NCEPOD

Gateway Health welcomes the findings of the NCEPOD findings reported. Since starting in 2006 Gateway Health has produced world beating results from its bariatric after care programmes. We continue to publish results that leave patients in no doubt which programmes will give them the best chance of a great long term outcome of their bariatric surgery.

As the NCEPOD report states, a multi-disciplinary team approach is the most effective care package and we have pioneered that approach since our inception. Using world leading surgeons, gastro-enterologists and nurses to lead our care teams, we continually produce great results and help set the standards used by organisations like The National Institute of Obesity Programme Practice Standards (NIOPPS). We accept their guidance and standards set, and ensure that we meet those standards for all our patients.

In recent times, we have seen a 10 fold increase in the number of patients who come to our clinics having had surgery with other companies. These patients are often at the end of their tether, and more often than not blame themselves for poor weight loss results. Some of these patients are as much as 4 years post surgery. It is our experience that in most cases it is poor education and aftercare that is the root cause, and we work hard with those patients to correct this with great success.

We feel that more power needs to be given to the Care Quality Commission (CQC) to deal with poor performing clinics and services. Monitoring of results of all patients is critical to this, as such we publish our results for all to see (A requirement of NIOPPS registration).

What is NDM-1?

NDM-1 stands for New Delhi metallo-beta-lactamase 1. It is a type of beta-lactamase, an enzyme that inactivates certain antibiotics (those of the beta-lactam class). The concern with NDM-1 is that it inactivates carbapenem antibiotics, an important class of drugs that is often used to treat serious and life-threatening infections.

Where is it a problem?

  • It’s currently mainly a problem in India and Pakistan.

Will is spread to other regions?
Probably. It’s easy for people to travel around the world quickly, and it’s easy for new microorganisms to travel with them. A bug that originates in one region can very easily spread across the planet. NDM-1 has been found in a few other countries, including Australia, parts of Europe and Canada. There is concern that the increase in health tourism (traveling to countries like India for cheap and quick procedures like elective surgeries) will result in spread of NDM-1, since people could pick up the bug in hospitals and bring them home. Transmission of NDM-1 in hospitals from patients that had healthcare procedures abroad has been documented in the UK. People traveling to regions where the organism is present for other reasons are also possible sources.

NDM-1 a risk to gastric band surgery abroad

Antibiotics’ efficiency wanes due to global spread of drug-resistant bacteria

Gene giving high levels of resistance to drugs found in increasingly prevalent intestinal bacteria

The efficiency of antibiotics is decreasing due to the spread of a bacterial gene conferring high levels of drug resistance. Photograph: Murdo Macleod for the GuardianInternational travel and medical tourism have led to the rapid, global spread of drug-resistant bacteria that may presage the end of antibiotics and leave doctors struggling to treat infected patients, scientists warn today.

A new gene conferring high levels of resistance to almost all antibiotics has been found to be widespread in forms of gut bacteria that can cause potentially life-threatening pneumonia and urinary tract infections.

In just three years, says Professor Tim Walsh of Cardiff University who discovered the gene, it has grown in prevalence from being rarely observed at all to existing in between 1% and 3% in patients with Enterobacteriaceae infections in India.

“It is absolutely staggering,” said Walsh. “Because of international travel, globalisation and medical tourism, [the gene] now has the opportunity to go anywhere in the world very quickly.”

Walsh’s paper on the spread of drug-resistant bacteria containing the gene appears today in the Lancet infectious diseases journal.

He and his colleagues have found NDM-1 (New Delhi metallo-beta-lactamase) 1 positive bacteria not only in India and Pakistan but also in the UK. Some of the infected British patients had travelled to India for kidney or bone marrow transplants, dialysis, pregnancy care or burns treatment, while others had undergone cosmetic surgery.

Walsh says it is not possible to know how widespread the bacteria now is in the UK. The Health Protection Agency has issued an alert, but doctors report only those cases they treat.

Alarmingly, there are only two antibiotics that still work against NDM 1-producing bacteria, and the likelihood is that they will also be overcome before long.

“In many ways, this is it,” he said. “This is potentially the end. There are no antibiotics in the pipeline that have activity against NDM 1-producing Enterobacteriaceae.”

Even if scientists started work immediately on discovering new antibiotics against the threat, he added, there will be nothing available soon.

“We have a bleak window of maybe 10 years, where we are going to have to use the antibiotics we have very wisely, but also grapple with the reality that we have nothing to treat these infections with.

“It is the first time it has got to this stage with these type of bacteria.”

Walsh and his colleagues’ work also shows that the NDM 1-producing bacteria are widespread not only in hospitals but quite probably in the wider community in India, where contamination of drinking water allows gut-borne bugs to be transmitted easily. Drug-resistant bacteria could also potentially be passed from one person to another in the UK, he said.

Ten years ago, scientists believed the greatest threat from drug-resistant infections involved what are known as Gram-positive bacteria, which include the so-called superbug MRSA (methicillin-resistant staphylococcus aureus).

But now, says the Lancet paper, clinical microbiologists increasingly agree that multidrug-resistant Gram-negative bacteria, which thrive in the gut, pose the greatest risk to public health.

Not only is the genes’ resistance to antibiotics growing more rapidly, but there are fewer new drugs to fight them.

Walsh discovered the NDM 1 gene after investigating the case of a patient in Sweden who was admitted to hospital in India infected with Klebsiella pneumoniae and E. coli bacteria.

The gene made the bacteria resistant to the group of antibiotics called carbapenems. The carbapenems are normally kept for emergencies and used when bacteria is found to be resistant to more commonly prescribed antibiotics.

The gene is carried on a plasmid, a small section of DNA that can move from one bug to another, passing on drug-resistance as it goes. These have, according to the paper, “an alarming potential to spread and diversify among bacterial populations.”

Walsh says: “The plasmids are highly promiscuous.”

Given the likely worldwide spread of these multidrug-resistant bacteria, the paper says: “It is disturbing … to read calls in the popular press for UK patients to opt for corrective surgery in India with the aim of saving the NHS money.

“As our data shows, such a proposal might ultimately cost the NHS substantially more than the short-term saving and we strongly advise against such proposals.”

In a commentary in the journal, Johann Pitout from the University of Calgary in Canada calls for patients who have received medical treatment in India to be screened before they are admitted for care back home. He warns that medical tourism, fuelling the spread, could grow in India by 30% every year over the next five years.

• This article was amended on 12 August 2010, to include a link to Tim Walsh’s paper in the Lancet

TOO MANY PRIVATE HOSPITALS FAILING PATIENTS WHEN IT COMES TO WEIGHT LOSS SURGERY, WARNS LEADING SURGEON

One of the UK’s leading bariatric* surgeons has expressed serious concern about the extremely poor levels of aftercare being provided to many weight loss surgery patients by private hospitals who offer ‘cut-price’ surgery both here and abroad.

Consultant laparoscopic and bariatric surgeon David Kerrigan, the Royal College of Surgeons’ representative who advised the government on the NICE obesity guidelines in use today, said the lack of follow up care provided by some hospitals was ‘shocking’ and could put patients’ lives at risk.

“I have long been concerned about hospitals who in effect abandon patients after surgery to keep costs down and make a bigger margin then just turn a blind eye when things go wrong,” said Mr Kerrigan, former secretary and founder member of the British Obesity Surgery Society.

“It takes a great deal of money and commitment to put the resources in place to allow patients 24/7 access to the surgeon and his team and provide specialist medical advice at every step of the way following bariatric surgery.

“What I strongly object to is the way in which certain private hospitals offer surgery on the cheap at the expense of the aftercare and the patients never see the surgeon again.

“In my opinion, it’s absolutely vital that the surgeon who operated is directly involved in the patient’s aftercare. Some hospitals simply have an advisor or a nurse at the end of the phone and it’s just not acceptable.

“Patients often think they’re getting a good deal but sadly cut-price weight loss surgery generally means cut-down care,” adds Mr Kerrigan, who is also medical director of Gravitas, a network of weight loss surgeons in the UK and Ireland committed to working to the highest ethical and professional standards in bariatric surgery.

“Patients need to be cautioned strongly about what they are letting themselves in for. Adequate medically supervised aftercare is essential to ensure that they receive not just a good result, but a safe one.”

As Mr Kerrigan points out, this is particularly critical with gastric banding**. “What patients often don’t realise is that follow up care is absolutely crucial to getting the result they want.

“Sometimes complications can set in months or even years after the operation is performed and need to be picked up quickly under the ongoing care of a surgeon who can deal with a problem at the drop of a hat. If they are not, the patient could be seriously at risk.

“The trouble is, if complications develop and a patient can’t get easy access to a specialist surgeon, it’s often left to the NHS or the local GP to pick up the pieces. Patients may well end up seeing a non specialist who has no idea what to do. It’s a dreadful state of affairs.”

Mr Kerrigan said he was concerned too about the worrying number of reports filtering through about certain private hospitals who bend the NICE guidelines by operating on ‘desperate’ patients with a body mass index (BMI) of less than 35 who do not meet the criteria as they are too light for surgery.

“It’s professionally and ethically wrong for private hospitals to perform specialist surgery outside the NICE guidelines for what can only be described as pure financial gain,” he said.

“Although this has been happening in Europe for a while, it’s disturbing that it now seems to be occurring in the UK too. Bariatric surgery should never be carried out just because a patient is desperate to lose a bit of weight for cosmetic reasons,” he said.

“This type of specialist surgery should not be undertaken lightly. Although it’s an extremely effective and valuable treatment in heavier patients, in lighter ones it’s like taking a sledgehammer to crack a nut.”

Mr Kerrigan added that successful weight loss is very dependent on the strength of the partnership patients develop with their surgeon and his or her team.

“They will need the surgeon’s help long after their operation has been performed if they are to get the most out of it,” he said. “Sadly, not all weight loss surgery providers are willing to make this commitment to their patients.

“The sad truth for many patients is that they don’t realise when they are being sold cut-price surgery that they will not be receiving the complete package of care necessary to maximise the chances of a safe and successful outcome.” ENDS

*weight loss

** An effective weight loss surgery procedure used to help overweight people achieve significant and long-term weight loss.

About David Kerrigan

MD with Distinction (1992), FRCS, FRCSEd (1986), MBChB (1982)

Honorary senior lecturer in surgery at the University of Liverpool, Mr Kerrigan practises at the Spire Murrayfield Hospital, Wirral and is amongst the elite of UK bariatric surgeons. He is medical director of Gravitas, which has created a pioneering network of doctors and surgeons in the UK and Ireland committed to working to the highest ethical and professional standards in bariatric surgery. Awarded the prestigious ‘team of the year’ accolade for innovative surgical practice by the independent Association for the Study of Obesity in 2009, Gravitas treats both private and NHS patients and has helped train many bariatric surgeons in the UK through its fellowship programme for senior surgical trainees. Widely respected by both the public and his surgical peers for his technical skill and commitment to uncompromisingly high standards of bariatric care and aftercare, David Kerrigan is a pioneer of laparoscopic (keyhole) bariatric surgery in the UK and has lectured widely on this subject both here and abroad. His work has been featured in numerous television and newspaper reports.

Weight Loss Surgery Programmes

With so many weight loss programmes (such as Weight Watchers or Slimming World) and self help weight loss support groups available, which one is right for you? The quality and effectiveness of these programs vary widely, from reputable weight loss surgery clinics associated with hospitals to quick weight loss progammes that could even harm your health with unregulated “miracle” products.

What to look for in a weight loss programme

Patients on the Gateway Health weight loss programme lose, on average, more than twice the percentage of excess weight when compared to other published studies. All staff and surgeons working with Gateway Health are leaders in the field.

The diary of a gastric band patient

Follow the gastric band patient diary of Michelle from Nottingham as she follows the Gateway Health programme Read More…..

It’s Official! The Gateway Weight Loss Management Programme produces World Leading results!

Patients on our programme lose, on average, more than twice the percentage of excess weight when compared to other published studies.
In a recent multi-centre study, patients on the Gateway Health weight loss programme achieved a much greater weight loss.