Overweight Obesity

Surgery?

Definition of Obesity according to BMI

Underweight <18.5Normal 18.5 – 24.9Overweight 25-29.9Obesity >30

moderate 30.0 – 34.9severe 35.0 – 39.9morbid >40

BMI = W(kg)/H (m²)

What Causes Obesity ? Obesity develops when energy intake

consistently exceeds energy output Complex disease involving:

- genetics - physiology- metabolism - appetite regulation - environmental factors

- psychosocial & cultural

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Positive energy balance Genetic component

Chronic sleep loss

Consumption of food, independent of caloric content, cause metabolic changes that incease body fat (processed meat, high sugar etc)

Low intake of fat-fighting foods such as fruits and vegetables

Stress and psychological distress

Many types of medications

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Medical Problems from Obesity

• Many medical problems are caused by or worsened by obesity.

• Most get better or go away with significant weight loss.

• These medical problems are called comorbidities.

Obesity Comorbidities• High Blood

Pressure• Diabetes• High Cholesterol• High Triglycerides• Heart Disease• Joint Pains• Difficulty

Breathing• Sleep Apnea

• Heartburn• Urine Incontinence• Varicose Veins• Difficulty Exercising• Fatty Liver• Increased Cancer Risk• Frequent Headaches• Sex Hormone Problems

Metabolic Syndrome

Abdominal obesityHyperinsulinemiaHigh fasting plasma glucoseImpaired glucose toleranceHypertriglyceridemiaLow HDL-cholesterolHypertension

Risk of Death and Obesity

0

100

200

300

15 20 25 30 35 40

BMI

D

E

A

T

H

Difficulties in daily living10

• Moving is hard• Tiredness• Dyspnea

Problems during transportation

Difficulties with hygiene

Psycho-social problems

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Negative selfesteem Social isolation Discrimination

Why Lose Weight ?

• Feel Better• Quality of Life• Look Better• Be Healthier• Avoid Discrimination• Live Longer

Treatment Options

• Diets• Exercise• Behavior Modification• Medication• Surgery

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Diets Don’t Work !

• Almost anyone can lose weight dieting• Almost no one can maintain long term

weight loss• 97% of patients 100 pounds or more

overweight regain lost weight within 2 years

• Often gain more than was lost

Exercise

• Very important as part of any weight loss program

• Regular exercise causes more weight loss and keeps it off longer

• Length of time is more important than intensity

• Rarely enough as treatment alone

Medications

• Cause only modest weight loss 10-15%• Need to be taken indefinitely• Often cause side effects• Expensive and often not covered by

insurance• Only work well in combination with diet

and exercise

Preoperative Preparation

1. Cardiac 2. Pulmonary3. Endocrine4. Psychiatric 5. Gastro-intestinal6. Dietician 7. Weight Loss

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Indications for Surgery

• BMI > 40 kg/m2• BMI > 35 kg/m2 with co-morbidities

• Comorbidities:– Hypertension– Diabetes– Hyperlipidemia– Sleep apnea– Severe arthrosis NIH Consensus

Conference Ann Intern Med 1991

Indications for Surgery

• Age > 18 or < 60• Failure of diet > 6 months• Obesity history > 5 years • Low risk for surgery• No endocrinological disease• Psychologically sound

NIH Consensus Conference Ann Intern Med 1991

Operations for Obesity22

Laparoscopic technique23

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Biliopancreatic diversion

Sleeve gastrectomy27

Easier operation No dumping Normal uptake of food

But… • No long-term studies

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Risks of sleeve gastrectomyPostoperative complications

• Comparable with a cholecystectomy

Mortality < 1/2000

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Early complications

Late complications

Bleeding Unsatisfactory weightloss

Leakage GE-reflux

Adjustable gastric banding35

Affect satiety Adjustable Safe Reversible

Gastric banding36

Complications

• Band Slippage 3-5%• Band Erosion 1-3%• Tubing Leak 2-3%• Port Infection 1-2%• Stomach Perforation <1%• Esophageal Dilation ?• Death <0.1% (less than 1/1000)

Patients preop workup Knowledge of procedure Preparation

• Weightloss• Stop smoking Quit certain drugs

Eating behavior

Physical exercise

Vitamins

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BARIATRIC SURGERY IN NAIROBI AND KENYA EABC -MEDICAL TREATMENT 57-70

PATIENTS PER YEAR 20 -30 PATIENTS UNDERGO DIFFERENT

SURGERIES PER YEAR THROUGH OUR CLINIC

IN COLLABORATTION WITH MOH ORGANISED FIRST OBESITY SYMPOSIUM

SECOND SYMPOSIUM IN PROGRESS NOW

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CONTINUATION FREQUENT RADIO, NEWSPAPERS, MEDIA

INFORMATION ABOUT OBESITY AND TREATMENT

BARIATRIC TREATMENT IN MOMBASA SEVERAL SURGEONS UNDERWENT

TRAINING TO BE EXPERT IN BARIATRIC SURGERY

NEED OF COOPERATION AMONG ALL SPECIALISTS

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