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Fight obesity with effective and guaranteed tools

t. Fight obesity with effective and guaranteed tools. Haitham Al-Khayat, MD Consultant general and bariatric surgeon New Dar Al-Shifa hospital. Obesity.

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Fight obesity with effective and guaranteed tools

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  1. t Fight obesity with effective and guaranteed tools Haitham Al-Khayat, MD Consultant general and bariatric surgeon New Dar Al-Shifa hospital

  2. Obesity Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems. Obesity is the 2nd most common cause of death from a modifiable behavioral risk factor

  3. Obesity related comorbidity Type II DM Hypertension Cardiac diseases Strokes Hyperlipidemia Respiratory diseases Degenerative osteorthritis Depression GERD Nephrotic syndrome Infertility Venous stasis ulcers Pseudotumor cerebri

  4. Causes of obesity Behavior Genetics Environment

  5. Environment portion size

  6. Nonoperative treatment how does it add up?? Nonoperative treatment how does it add up?? Diet Exercise Behavioral therapy + Drug therapy . ??????

  7. Why Surgery? Diet and exercise are not effective long term in the morbidly obese Surgery is an accepted and effective approach Surgical risk is acceptable vs. risk of long-term obesity

  8. Surgery is effective

  9. Surgery is effective Pre-operative Medications Post-operative Medications

  10. Surgical treatment of obesityIndication of surgical options

  11. Patient selection BMI ≥ 40 kg/m2 OR BMI 35 - 40 kg/m2 with significant comorbidity High risk health problems Ineffective documented dietary attempt

  12. The Gastrointestinal system

  13. Operative approaches Restrictive Procedures Adjustable silastic gastric banding (ASGB) Sleeve gastrectomy Gastric plication Combined Procedures Roux-en-Y gastric bypass ( GBP )

  14. Lap Band • Restrictive • Reversible • 40-55% EBW loss

  15. Lap sleeve gastrectomy • Restrictive • Very popular in Kuwait • 60-70% EBW loss • Relatively new with unknown long term consequences

  16. Roux En Y gastric bypass • First done in 1967 • 60-70% EBW 14 year followup

  17. Results of bariatric surgery Weight loss Resolution or improvement in comorbidity Increased longevity Improved QOL Health Social Personal Work

  18. General Complications of Weight-Loss Surgery Post-operative depression Food issues Changes in relationships Hair loss Usually temporary Cause: protein, vitamin A, mineral Excess skin

  19. Weight loss program team Surgeon Nurse practitioner Dietitian Anesthesiologist Nurses Cardiologist SAFETY and RESULTS

  20. Final words * Surgery is only a tool * Patients must commit to lifelong changes in diet and behavior * Think seriously about options * We are here to help

  21. Defining the Problem

  22. The Problem Prevalence of obesity in U.S. increased from 12% to 21% between 1991 and 2001 = 15 million people Obesity is the 2nd most common cause of death from a modifiable behavioral risk factor 111,909 excess deaths annually Mokdad AH et al.JAMA. 2003;289:76-79 Flegal KM et al. JAMA 2005;293:1861-1919

  23. Excess U.S. Medical Costs Related to Abnormal Body Weight Int J Obesity 2005;29:334-339

  24. Greatly increased Moderately increased Slightly increased (relative risk 2-3) (relative risk >>3) (relative risk 1-2) Cancer (breast cancer in Coronary heart disease Diabetes postmenopausal women, Osteoarthritis (knees) Gall bladder disease endometrial cancer, colon cancer) Hyperuricemia and Hypertension gout Reproductive hormone Dyslipidemia abnormalities Insulin resistance Polycystic ovary Breathlessness syndrome Sleep apnea Impaired fertility Low back pain Increased anesthetic risk Fetal defects arising from maternal obesity Relative risk of health problems associated withobesity

  25. The Effect of Obesity on the Development of Health Risks 50 100 93 Men1 Women2 42 40 75 30 50 40 20 12 25 10 2.2 8.1 1.0 1.0 0 0 <23 25 31 <22 25 31 35 35 BMI Age-adjusted relative risk of type 2 diabetes 1Chan JM et al. Diabetes Care 1994;17:961-969; 2Colditz G et al. Ann Intern Med 1995;122:481-486.

  26. Fed up with how her diet is going Charlene takes a more serious aim at her target weight

  27. Weight Maintenance after Bariatric Surgery Sjöström L, Lindroos AK, Peltonen M et al. N Engl J Med. 2004;351:26

  28. Conclusions Bariatric surgery is an effective means to achieve clinically significant, permanent weight loss with low rates of complications. Bariatric surgery results in significant improvement in health risks associated with obesity. Surgical weight loss increases life-span. Surgical therapy is cost-effective.

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