Western world lifestyles consist of stressful jobs, limited free time, high calorie foods, unhealthy eating habits and lack of exercise has led to more than 60% of the American and UK population, and greater than 50% of the Western European population, being clinically overweight or obese. After smoking, obesity and being overweight is deemed, to be the leading cause of preventable early death in the Western World.
Being overweight is something which affects not just your health, but very often also your mental well-being and happiness.
At the Specialist Medical Clinic, we understand that losing weight is not that easy. Research shows that 85% of people who try to lose weight on their own fail to reach their goal. Being mentored and regularly supported during your weight loss journey significantly increases your change of shedding your excess kilos.
We therefore offer a multi-disciplinary approach to weight loss which includes lifestyle advice, dietary advice and the 1:1 Diet by Cambridge Weight Plan as well as a range of surgical options.
Statistics show that approximately 25% of the UK adult population are severely overweight (Body Mass Index / BMI >30). The World Health Organisation classifies anyone with a BMI greater than 25 as being “overweight” and anyone with a BMI greater than 30 as “obese”.
The 2021 Gibraltar Public Health and Lifestyle Report found that 66% of the population are overweight or obese, with three quarters of men aged 45 and over being overweight Our-Nations-Health-final-2021.pdf (healthygibraltar.org)
What are the risks of being obese?
People who are overweight or obese are much more at risk of developing comorbid diseases than people of “normal weight”. These risks are cumulative with increasing BMI, and often improve dramatically following weight loss and lifestyle changes.
As BMI increases, people are much more at risk of having impaired glucose tolerance issues which leads to type II diabetes. Obesity is also associated with hypertension (high blood pressure) and heart problems because more pressure is needed to pump blood around the body
Obesity is associated with an increase incidence of breast, colon, rectum, kidney, pancreas & primary liver cancer. In women, increasing obesity is associated issues with fertility issues and an increased risk of complications during pregnancy.
Other risks associated with obesity include impaired mobility, arthritis, musculoskeletal pain, fatigue, increased drug consumption (for medical conditions) with poly-pharmaceutical drug side effects. Psycho-social logical health problems including depression, low self-esteem, reduced self-confidence and social withdrawal are also more common as weight increases into the obese and super-obese ranges.
Whilst losing weight by way of lifestyle changes and self-directed calorie reduction are the ideal solution, supervised meal replacement diets and surgical treatments are also available to help overweight and obese patients lose weight.
If you are overweight or obese, weight loss is probably the most important thing you can do to improve your physical and mental wellbeing.
Diet and Lifestyle changes
An excellent starting point for anyone wishing to lose weight, is to begin with a diet and lifestyle assessment. A few small changes in these areas can set patients on the road to a healthy target weight without the need for surgery.
For those with a BMI of 25-35, small lifestyle changes can result in a weight loss of around 10kg. Changes such as altering eating habits, starting exercise programmes and behaviour modification strategies can all have a positive effect.
Supervised Calorie restriction and meal -replacement products
For many, a tool such as a meal replacement diet plan, provided under the supervision of a trained diet coach can lead to spectacular results. The 1:1 Diet by Cambridge Weight Plan was used as the weight loss product in 3 ground-breaking studies which linked weight loss with the reversal of pre-diabetes and type 2 diabetes.
The PREVIEW study showed that as little as a 4% reduction in body weight could reverse the biochemical signs of pre-diabetes which the DiRECT study finally shoed that type 2 diabetes could be reversed if a nutritionally balanced calorie restricted diet was used under supervision to help people lose circa 10kg or more. The DROPLET study showed that dedicated weight loss coaches were much more successful at achieving significant weight loss than standard NHS practice.
Bariatric (Weight Loss) Surgery
For some patients, lifestyle and supervised diet plans (with or without calorie- controlled meal replacements) do not work. There are many complex reasons for this, but in many of these cases it may become necessary to consider a surgical intervention.
These treatments are referred to as Bariatric Procedures of Bariatric Surgery. Broadly speaking these interventional tools can be classified as
- Restrictive – which reduce the amount of food consumed
- Malabsorptive – which alter the body’s ability to absorb nutrients from any food eaten.
Restrictive Bariatric Procedures
These are operations which “restrict” the amount of food that can be consumed during one meal. These procedures therefore effectively reduce the size of the stomach WITHOUT the need to alter the natural anatomy and physiology of the digestive tract. Broadly speaking restrictive bariatric procedures are reversible.
This is a restrictive surgery which was very popular in the past but has lost favour in recent years as the Gastric Sleeve procedure was introduced.
The adjustable gastric band is a synthetic device which is placed around the uppermost part of the stomach via a laparoscopic surgical procedure. The band locks in place and the surgeon creates a very small “pouch” of stomach above it which becomes the new “neo-stomach” which fills quickly and tricks the brain into thinking the patient is full. The band in inflated with water via a catheter which has a filling port directly under the skin in the upper abdomen which allows the band to be filled or emptied in order to increase or decrease the rate of emptying of the new small stomach.
After placement patients can only tolerate eating small meals. When the “neo-stomach” is full, messages from the pouch lining cells the brain that enough has been eaten and the patient feels full.
The “neo-stomach” then empties slowly through into the main stomach. The rate at of emptying is controlled by the band.
Gastric Bands whist very popular, are associated with some complications many of which required corrective surgery. For these reasons and the more recent introduction of the Gastric Sleeve procedure, the gastric band has become a less popular bariatric procedure.
This is a more recently introduced procedure which involves the removal of part of the stomach to reduce its volume by reducing its diameter. It is a modern modification of a procedure called “Vertical Banded Gastroplasty” which was extremely popular back in the 1980s. Surgeons perform the operation laparoscopically and create a “tubular” stomach by removing most of the fundus and body of the stomach which leaves the remaining stomach resembling a “sleeve”. The operation involves the removal the uppermost (fundus) part of the stomach which is important in regulating satiety.
Whilst this operation is technically a “restrictive” bariatric operation, the removal of the gastric fundus does interfere with normal eating physiology.
Malabsorptive Bariatric Procedures – Gastric By-Pass
These operations are designed to reduce the number of calories and nutrients patients absorb from the food they eat. In order to achieve this the surgeon has to do 2 things:
- Reduce the size of the stomach (often by removing the major part of the organ) which reduces the size of meal that can be eaten by the patient.
- Reorganisation of the small intestines in a way such all ingested food “by-passes” a large section of the small intestine so that food spend less time in the small intestinal tract. This means that there is less time for the gut digestive enzymes to break down food and a much shorter length of intestine from which nutrients (carbohyrates, fat, protein, vitamins and minerals) can be absorbed into the blood stream
So having a gastric bypass effectively means that the patient can only eat small meals and their body digests less food.
There are a variety of different gastric bypass operations that are available to the surgeon. Each surgeon has their preference and normally only performs one or two types of operation.
Because these operations involve cutting the intestine and suturing it back together in different places. Surgical complications associated with gastric bypass operations are higher than those seen with restrictive procedures. Most patients also need long biochemical monitoring and nutrient supplementation after gastric bypass surgery.
At the Specialist Medical Clinic, our team of experienced surgeons will discuss all of the available options and agree a treatment plan which is best suited to your needs.
How can we help you today?
Mr. David Deardon BM MD FRCS FRCS(Ed)
Chief Executive / General Surgeon & Endoscopist
Dietetic Nurse and Nutrition Specialist