breaking the obesity cycle
Jenny Bryan and Rachel Newcombe
surgical intervention
Not everyone is able to lose weight through dieting and exercise and there are instances where surgery becomes the only option. According to a review in the medical journal, The Lancet, the number of weight loss ops performed has increased five times over the last five years. Although a last resort for many people, it appears to reduce the risk of death for morbidly obese people by between 29% and 40%.
Weight loss surgery is not an option available to everyone. Guidelines produced by the National Institute for Clinical Excellence (NICE) state that you have to have a BMI of 40 or over to be eligible for surgery. The only exception is people who have a BMI of 35 or over and are suffering from an obesity-related health condition such as diabetes, high blood pressure, heart disease, arthritis or asthma. Patients have to have tried all other treatment options first, including medical therapy, be fit enough to undergo the surgery and have an anaesthetic.
It's a form of major surgery, complications can occur and there are risks involved. In fact, being obese makes surgery more risky. But if you're severely obese to start with, there are risks with remaining in that state of health too, so it becomes a case of weighing up the risks and benefits of each. Anyone considering surgery will be advised carefully by their doctor or surgeon so they understand the risks from the beginning and know what is involved with the surgery.
Dr Colin Waine, chair of the National Obesity Forum, says, 'For a small section of people, surgery can bring huge benefits. Some people are so at risk that they are going to die from other causes without surgery.' However, he emphasises that surgery is only applicable for the 'more extreme end of the spectrum' and shouldn't become an easy way out for people who are overweight.
types of operations
There are various types of weight loss operations available and patients are advised by medical experts as to which would be the most suitable to them. Two of the operations often used are gastric bypass surgery and stomach stapling (vertical banded gastroplasty).
Roger Ackroyd, a consultant surgeon at Thornbury Hospital in Sheffield, explains what's involved in a gastric bypass operation. 'The upper stomach is either stapled or divided to create a small gastric pouch. The small intestine is also divided at a lower point and is joined to the pouch.' This makes the stomach smaller and removing part of the small intestine – bowel – it makes the digestive system shorter. 'This means that food will no longer enter the main portion of the stomach, but instead will bypass this area and go directly to the bowel.'
'Gastric bypasses help weight loss by restricting the amount of food that's able to be eaten and affecting what is absorbed,' he added. People who've had a gastric bypass have to eat smaller meals and as the food passes through the body in a different way, fewer calories are absorbed.
Stomach stapling operations work slightly differently. 'With stomach stapling, no part of the stomach is removed. Staples are placed across the upper stomach to create a small pouch with a narrow outlet. Around this we place a silicone band. The band restricts the amount of food that can be eaten and, if the patient eats too much, it may make them vomit,' he said.
In 2001, Roger had only eight obesity surgery patients. Last year he conducted over 400 operations.
Studies show that people who've had gastric bypass surgery on average lose about 66% to 75% of their weight within two years. Sadly, the surgery does carry risks and complications do occur – some during the operation and others after, as was the case for Renee Williams, the 841-pound Texas woman who was the largest female ever to undergo gastric bypass surgery. There's a one in 100 risk of someone dying from gastric bypass surgery, but for many of those considering the operation, it's a risk they're willing to take.
(July 2001, resources updated March 2005)
