Dr Pradeep Jain Reviews, Fortis Hospital - Why, Who, When and What of Weight Loss

Why, who, when and what of weight loss surgery

Dr Pradeep Jain, M.Ch

DirectorDept of Lap GI, GI Cancer and Bariatric Surgery Fortis Hospital Shalimar Bagh &Namokar Gastro Clinic IA 46 A Ashok Vihar Phase 1 Opp Mont Fort School

Obesity

Excess body fat leading to deleterious effect on health

BMI ( Body Mass Index )Weight (kg) / square of height

( meters )

Problem of obesity in IndiaNational health survey (2007)

15% of Indian population fat

Out of these 1/3rd are morbidly obese

WHY ARE WE SO OVERWEIGHT??• Consumption of foods high in

calories (excessive sugar and fat)• Consumption of too much

food (large portions)• Not enough

exercise/sedentary lifestyle• Inheriting “fat genes” from

our parents/relatives

Obesity – a complex disease

Fat ? So what ? Weight comes with a price

High blood pressure Diabetes Heart attack Sleep Apnea Arthritis InfertilityCancers Depression Incontinence

Impact of BMI on Longevity

www.infinitysurgery.com

Impact of Obesity on Mortality and Years of Life Lost

Graph represents years of life lost for white men.Fontaine KR, Redden DT, et al. Years of life lost due to obesity. JAMA 2003;289:187.

Why should treat obesity at all To increase survival Improve quality of life Social acceptability Decrease medicine intake Decrease hospital expenses

AIMSSustained weight loss

Good quality of life

Resolution of obesity related diseases

Low risk treatment modality

What to do ?Diet regulationExercise Medicines Surgery

Disadvantages of medical treatment

• Most patients (95-97%) regain most or all of the weight that was lost within 2-5 years following diet or drug treatment

• The average amount of weight loss is

relatively small – 5-10 kg • Drug therapy may be associated

with severe complications.


Medical vs Surgical Therapy for Obesity

Medical (lifestyle changes and pharmacotherapy) vs Surgical Therapy for Obesity

-25

-20

-15

-10

-5

0

5

0 6 12 18 24

Months

Per

cen

t E

xces

s W

eigh

t L

oss

SurgicalMedical

Source: O’Brien PE, Dixon JB, Laurie C, et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program. Ann Intern Med. 2006;144:625-633.

Weight

(lbs.)

Why Surgery ?Only known method for sustained

weight loss Risks are far less than risk of

continuing with morbid obesity and associated problems

Lead to hormonal changes leading to resolution of co morbidities

Increase satiety

Schneider BE, Mun EC .Surgical Management of Morbid Obesity. Diabetes care 2005;28(2): 475-80

Contraindication for bariatric surgeryHistory of substance abuse,

eating disorder,or major psychiatric problem

which is untreated and/or unresolved Patients who are too ill or too

high a risk for surgeryWomen who may become

pregnant soon

Types of surgeryGastric banding Sleeve gastrectomy Gastric bypass Liposuction NO

Roux en Y Gastric Bypass

Sleeve Gastrectomy

Gastric Banding

What is the postoperative diet Liquid diet for 2-3 weeks Puree diet for 1-2 wksSoft diet for 1-2 wks Normal diet after that Avoid sweets, aerated drinks ,

drinking water with meals Regular supplements

Concerns after surgeryIs it safe ?What are the side effects or complications ?Will I continue to loose weight and become

below normal ?What will be my diet after surgery ? Will I require medicines through out life? Will there be any problem in getting pregnant ?Will there be regain of weight after some time? How much time it will take to reduce weight ?Will my tissues and skin get loose after

surgery ?Is it reversible?


Bariatric Surgery Has a Low Incidence of Mortality

1Mortality rate when performed at a Bariatric Surgery Center of Excellence; Bariatric Surgery: DeMaria EJ, Pate V, Warthen M et al. Baseline data from American Society for Metabolic and Bariatric Surgery-designated Bariatric Surgery Centers of Excellence using the Bariatric Outcomes Longitudinal Database, Surgery for Obesity and Related Diseases. Article in Press.2Dolan JP, Diggs BS, Sheppard BC et al. The National Mortality Burden and Significant Factors Associated with Open and Laparoscopic Cholecystectomy: 1997–2006. J Gastrointest Surg. 2009; 13:2292-23013Lie SA, Engesaeter LB, Havelin LI et al. Early postoperative mortality after 67,548 total hip replacements. Acta Orthopaedica 2002; 73(4):392-399 4Ricciardi R; Virnig BA, Ogilvie Jr. JW. Volume-Outcome Relationship for Coronary Artery Bypass Grafting in an Era of Decreasing Volume. Arch Surg. 2008;143[4]:338-344

Bariatric Surgery Lap Chole Hip Replacement CABG0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

3.50%

0.13%

0.52%

0.93%

3.30%

Mortality Rates (%)

1 2 3 4

Medical Co-Morbidities Resolved after Bariatric Surgery

Type 2 Diabetes 95%

Hypertension 92%

Osteoarthritis 82%

Cardiac Function Improvement

95%

Stress Incontinence 87%

GERD 98%

Cholesterol 97%

Sleep Apnea 75%

Wittgrove AC,Clark GW. Laparoscopic Gastric bypass roux-n-y-500 patients. Obes Surg 2000. And others.

Our Department

Our DepartmentMost qualified and

Superspecialized Department for any surgery Laparoscopic surgery on Gastrointestinal Tract

Perfect teamwork including Surgeons, dietician, endocrinologist, physiotherapist, for long term follow up

Highly qualified surgeons to handle all situations and complications

Results

Lost 51 kg 7 months

Lost 30 kg in 9 months

Lost 23 kg 3 months

Bariatric Support Group ( V care)Monthly meeting with old

patients, Potentially surgical patients, Doctors, Dietician, physiotherapist and support staff

Old and new patients are encouraged to speak about their experiences, innovations so that all can learn together.

Thank you

Dr Pradeep Jain Reviews, Fortis Hospital - Why, Who, When and What of Weight Loss

Health & Medicine

Transcript of Dr Pradeep Jain Reviews, Fortis Hospital - Why, Who, When and What of Weight Loss