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Obesity – Surgical and other interventions Stephen Pollard Consultant Surgeon St James’s University Hospital and Leeds

Obesity – Surgical and other interventions Stephen Pollard Consultant Surgeon St James’s University Hospital and Leeds Spire Hospital Cutting Edge Surgery February 2009. Classification by Body Mass Index (BMI; kg/m 2 ). <18 underweight 18-25 desirable 27-30 overweight

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Obesity – Surgical and other interventions Stephen Pollard Consultant Surgeon St James’s University Hospital and Leeds

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  1. Obesity – Surgical and other interventions Stephen Pollard Consultant Surgeon St James’s University Hospital and Leeds Spire Hospital Cutting Edge Surgery February 2009

  2. Classification by Body Mass Index(BMI; kg/m2) • <18 underweight • 18-25 desirable • 27-30 overweight • 30-35 obese • 35-40 with med problems or >40 morbidly obese • >50 superobese • >60 super-super obese • >70 ultra-obese

  3. The size of the problem in the UK • Prevalence of obesity: 1980 1993 1998 2002 2006 • Male 6 16 21 24 29 • Female 8 13 17 21 24 • Overall, 3% of adults are morbidly obese • 30-50,000 deaths attributed to obesity per annum • 1.2 million fulfil NICE criteria for surgery

  4. European Charter on Counteracting Obesity (WHO; 2006) Recognised surgery as the only effective treatment for morbidly obese patients Reported European data: • 150,000,000 obese adults • 15,000,000 obese children • 1,000,000 deaths per annum • http://www.euro.who.int/Document/E89567.pdf

  5. The size of the problem worldwide • >1 billion people are overweight • >Quarter of a billion are obese • More people suffer from obesity than from malnutrition

  6. The cost of obesity • In the UK • Estimated healthcare costs of £6.6 – £7.4 billion per year (NICE, Dec 2006) • US - $75 billion

  7. Socio-economic class % of adult population with BMI>30 SE class 1 5 Male 11 16 Female 14 28

  8. The future of bariatric surgery “Predictions are risky, particularly when made about the future” Senator Dan Quayle, Former U.S. Vice President

  9. Obesity in Children • 8.5% of 6 year olds are obese • 15% of 15 years olds are obese • 90% of obese children become obese adults But • Average intake of calories per meal has remained unchanged since 1945 So what has changed? • Snacking on energy dense high calorie foods between meals and a more sedentary lifestyle • 1985 – 80% of children walked or cycled to school • 2003 – 5% of children walked or cycled to school Dec 2006 – NICE consider children suitable for surgery

  10. Even our dogs are getting fatter

  11. Weight is regulated with great precision. For example, during a lifetime, the average person consumes at least 60 million kcal. A gain or loss of 10Kg, representing approximately 90,000 kcal, involves an error of no more than 0.001%. The results of adoption and family studies show a heritability of obesity of about 33%. Genetic influences may be more important in determining regional fat distribution than total body fat, particularly the critical visceral fat depot. The converse of finding that genetic factors only influence a proportion of the variation in body weight means that the environment exerts an enormous influence.

  12. The issues of obesity • What has history told us? Mixed messages

  13. Idolised as a thing of beauty, prosperity and health

  14. A sign of good health

  15. Cardiac risk of obesity • Based on Framingham Heart Study • Risk of death within study period (26 yrs) increases by: 1% per pound overweight for 30-42 year olds 2% per pound overweight for 50-62 year olds BMI 25-30 equates to 3 years loss of life BMI >30 equates to 7 years loss of life BMI >40 equates to 15 years loss of life BMI > 30 + smoking equates to 13 years loss of life

  16. Risk of type 2 diabetes • In males – increase waist from <87.5cm to >101.6cm increases risk of type 2 diabetes 12 fold • If BMI>25, risk increases 5 fold • If BMI>35, risk increases 93 fold

  17. Obesity Related Comorbidity • Diabetes mellitus • Hypertension • Dyslipidaemia • Some cancers • Hypoventilation syndromes (OHS and OSA) • Asthma • Gastro-oesophageal Reflux • Gallstones and NAFLD • Osteoarthritis • Abdominal wall herniae • Neurological disorders • Androgenisation, polycystic ovaries and infertility • Psoriasis • Venous stasis and varicose veins • Affective disorders

  18. Pickwickian Syndrome • Comprises 2 syndromes: • Obesity Hypoventilation Syndrome • Obstructive Sleep Apneoa • They often occur together – some degree of overlap but 2 distinct conditions

  19. Obesity Hypoventilation Syndrome • Restrictive ventilatory failure • Characterised by daytime hypoxia due to alveolar hypoventilation – reduced ventilatory excursion in the presence of increased requirement • Progresses to respiratory failure and right heart failure • Diagnosed by arterial blood gas measurement PaO2< or = 7.3 kPa (55 mmHg)

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