Contents
Tackling obesity seems simple. Eat less, exercise more, lose weight. But, for many severely overweight people, diets and exercise just don’t work. Furthermore, repeated attempts lead to the yo-yoing of short-term success followed by inevitable weight-gain, resulting in frustration, despair and worsening health. Obesity is a growing problem worldwide and the number of people looking for a solution to reduce their weight is soaring. Obesity not only reduces life expectancy but it is also associated with a 40% higher risk of developing cancer. Weight loss can prevent this and lead to a dramatic improvement in obesity-related diseases such as diabetes, high blood pressure, heart disease and high cholesterol. Treating obesity can also reverse infertility in women and can improve the results of surgeries such as knee and hip replacements.
So what are the current options for losing weight?
1. Dieting and lifestyle measures
2. Medication
3. Surgical intervention
4. Endoscopic intervention
Dieting and lifestyle measures
Dieting is often described as the simplest and least invasive way to lose weight, however it also remains, in my opinion, the least effective method to lose weight. The reason is quite simple: it is very difficult for almost anyone to adhere to the strict dietary regimes necessary to maintain weight loss. We have all succeeded in losing a few stones here and there through pursuing calorie limiting diet plans, some of us have even joined the gym and tried to engage in exercise despite our hectic schedules! But how many of us can claim that months later, we have kept the weight off? It is really not surprising that our bodies are genetically programmed to defend our pre-diet weight. After all, in prehistoric times, having extra fat would be of great advantage during the winter months when our hunter-gatherer ancestors would struggle to find the next meal. A useful analogy is to think of your body having its own thermostat, not to regulate temperature but to control your weight. Lifestyle changes and certain medications can reduce your weight but ultimately your weight will return to its original (higher) setting. Unfortunately, the only known way of turning down this (weight-o-stat) setting and thus achieving significant sustained weight loss is through surgery.
Medication
Currently in the UK, there is one licensed drug for weight loss called Orlistat (aka Alli). This works through reducing the absorption of any digested fat, which then has to come out through bowel movements. These are often so unpleasant (smelly, offensive diarrhoea which may leak out if a toilet is not within reach) that most people are put off from continued use of this medication. However for those that continue with the tablets, an average weight loss between 5–8% is achievable over a one year period.
Surgical interventions
Bariatric or weight loss surgery is currently the most effective treatment for morbid obesity and has arguably the best long-term outcome. The gastric bypass operation resolves Type 2 diabetes within days of the operation. The three most popular procedures are laparoscopic gastric banding, gastric bypass, and sleeve gastrectomy (see below).
Bariatric surgery works in two ways: through reducing hunger and increasing fullness. With gastric banding, an inflatable plastic ring can be used to control the amount of food passing from the stomach into the digestive tract. (Click on images to see enlarged diagrams).
The gastric bypass operation enables food to skip some of the stomach and part of the small intestines, instead entering a small pouch that leads straight to the small bowel.
In the sleeve gastrectomy, the stomach is converted into a long thin tube by stapling it along its length and removing the excess. The food takes the regular route.
In the months following surgery, most people will lose between a quarter to a third of their total body weight and will, most importantly, keep this weight off. All the surgeries described above are performed by keyhole surgery which means very quick recovery, minimal pain and very, very small scars (often not noticeable after a year or so). Gastric band patients can go home the same day as surgery, sleeve gastrectomy and gastric bypass patients will stay in hospital for one to two days. As with all surgery there are risks, but when performed in centres of excellence, complication rates are minimal and the surgery extremely safe.
Endoscopic intervention
A more recent approach to weight loss is through using an endoscope (a small tube with a camera at the end inserted through the mouth and passed down to the stomach). A balloon (filled with water) the size of a melon is positioned in the stomach using the endoscope. The procedure is performed under deep sedation, does not require any cuts and can be done as a day case. The balloon occupying the stomach gives the sensation of fullness very quickly after a meal. Most people can lose between 15–20 kgs (3 st) but the main disadvantage is that the balloon has to be removed after six months. However, by this stage the brain has been conditioned to believe that the balloon is still present thus maintaining reduced food portions.
To Conclude
The health improvements to be had from weight loss surgery are vast, perhaps even more than from stopping smoking! But it is important to get specialist advice from an experienced recognised bariatric surgeon who works as part of a team with dedicated psychologists, dieticians and nurses, so that complete care (including all four treatment options listed above) can be offered to those contemplating weight loss.
