Obesity: How Prejudiced is the NHS?

[ickihun]

I fell over myself pretty early on - i/m fairly sure that was a function of having been living with blood sugars in the high teens for a couple of years, which then came down to 5 causing me to get dizzy.
do you still have the dizziness now? I found it has reduced now I am used to a lot lower sugar levels

It might be related to fluctuating bgs? I've had a few highs lately. I'm forgetting to take insulin when I'm up against everything. Although I read somewhere taking all your morning meds together can cause dizziness. I'm not sure if true. I'd forget some if I stagnated them.

The Newcastle team lead by Professor RoyTaylor has been shown that the very low calorie diet can work well for some participants, without the need for the surgery.
No single method will work for everyone.

That's true. There is a section on here with loads of successful participants. I know I'd just add more weight when I'd done the lotted time. I won't waste people's expertise and time.
I know, my current limitations.

 

[ickihun]

We do anaesthetise obese patients quite regularly so that's of the mark. My most recent patient was 150kg. My colleague's last week circa 200+. It just depends on what they are having done and whether the risk that comes with anaesthetising them for that particular procedure is warranted. Noone goes to work wanting to kill a 35 year old woman who just happens to be 196kg for the removal of a mole on the bum that's not as much of a risk to their life as securing their breathing because of their weight.

I'd rather be awake. One less thing to worry about. Less time in hospital too.

 

[serenity648]

We do anaesthetise obese patients quite regularly so that's of the mark. My most recent patient was 150kg. My colleague's last week circa 200+. It just depends on what they are having done and whether the risk that comes with anaesthetising them for that particular procedure is warranted. Noone goes to work wanting to kill a 35 year old woman who just happens to be 196kg for the removal of a mole on the bum that's not as much of a risk to their life as securing their breathing because of their weight.

I have been told that I cannot have any non-life threatening surgery unless i get my weight below a bmi of 30 : (

 

[serenity648]

My doctor is finally looking into the possibility of me having had peritonitis, with emergency appendix operation, resulting in losing part of my small intestine too, as causing me to perhaps have a long standing B12 deficiency. hence the symptoms of anemia, without having it show up on blood tests : shortness of breath, extreme fatigue.

 

[ickihun]

I'm a great believer in a problem should be bombarded from all angles to ensure that problem doesn't rear its ugly head again. Any problem.
I'll be using all the techniques I've learned over decades of diabetes to kick it into remission after surgery.
Currently I know deep down remissions are fragile. I bet more so once half your stomach has been removed and it cannot be done again.
Although I have to think of my health status now and do what's right... now!
I've received a training and intro 2hr group session for my bariatric surgery at the end of the month!

 

[JohnEGreen]

I'm a great believer in a problem should be bombarded from all angles to ensure that problem doesn't rear its ugly head again. Any problem.
I'll be using all the techniques I've learned over decades of diabetes to kick it into remission after surgery.
Currently I know deep down remissions are fragile. I bet more so once half your stomach has been removed and it cannot be done again.
Although I have to think of my health status now and do what's right... now!
I've received a training and intro 2hr group session for my bariatric surgery at the end of the month!

Good luck and wish you well in this.

 

[zand]

I'm a great believer in a problem should be bombarded from all angles to ensure that problem doesn't rear its ugly head again. Any problem.
I'll be using all the techniques I've learned over decades of diabetes to kick it into remission after surgery.
Currently I know deep down remissions are fragile. I bet more so once half your stomach has been removed and it cannot be done again.
Although I have to think of my health status now and do what's right... now!
I've received a training and intro 2hr group session for my bariatric surgery at the end of the month!

Are you having the bypass or the gastric band?

 

[ickihun]

Are you having the bypass or the gastric band?

Not sure but I think based on my current bmi they will want to do bypass.

I have been told that I cannot have any non-life threatening surgery unless i get my weight below a bmi of 30 : (

I might get told the same. I'll let you know. Im quite oblivious to what really happens. Ive just heard snippets.

My doctor is finally looking into the possibility of me having had peritonitis, with emergency appendix operation, resulting in losing part of my small intestine too, as causing me to perhaps have a long standing B12 deficiency. hence the symptoms of anemia, without having it show up on blood tests : shortness of breath, extreme fatigue.

Ive only started having problems when my mobility failed me. Ive always been very active and adventurous!

 

[ickihun]

@serenity648 I was overweight before my appendix burst (14yrs old).
I had diabetes symptoms at 6yr old. My father bought me a bidet for my thrush. I had them awake through the night all through my childhood.

 

[zand]

@ickihun sounds like the bypass might be your best bet anyway?

 

[Daphne917]

Thanks Zand, I'm pleased you got sorted, I don't think I would survive at 78 in June. My Afib is permanent but I don't have palpitations just missing beats or heart stopping moments. I got a pacemaker three years ago for bradicardia and repeated 4 Sec pauses over night , so I have a slow heartbeat but my pacemaker doesn't let it drop below 60bpm. I can walk 3miles OK but have bad days when I'm knackered! I'm on Pradaxa and eplerenone (the aldosterone antagonist) no other meds.best wishes ,D.

@zand and @lindisfel my husband has bracdicardia which is managed by a pace maker after an aortic anerysm operation 10 years ago when he was 50. He suffers from AF which is treated with Bisoprolol and Diltiazem Hydrochloride. The dosage of Bisoprolol was increased a couple of months ago after his cardiologist looked t his pacing records and found that his heart was beating too fast at night for quite long periods. It also goes through stages where it misses beats but doesn't last too long!

 

[NicoleC1971]

Ooh - next patient was referred to NHS weight management service and told to follow Eatwell Plate. She told them carbs were an issue, and was pressured to follow Eatwell. Gained 2 stone while under weight management service.

Just been approved for gastric bypass.

The presenter was a bariatric surgeon and rightly frustrated that this effective solution for obesity isn't being utilised seemingly due to medical ignorance and the underlying assumption that obesity is a character flaw (gluttony and sloth or itskinder modern equivalent - emotional /binge eating). But there are ways to get the same results without the surgery - fasting in its various forms or low carbing. In the case of fasting there seems to be evidence that it corrects the hormonal defects that cause 'diabesity' in the first place. Congrats on getting onto the list for surgery btw!

 

[BarbaraG]

In the case of fasting there seems to be evidence that it corrects the hormonal defects that cause 'diabesity' in the first place.

That's encouraging! Can you refer me to some evidence? I'd like to see it.

Congrats on getting onto the list for surgery btw!

Not me - the woman in the film!

 

[wood678]

I just watched this program, some interesting stuff about the changes to hormones etc, I would be interested to see a comparison of the blood profiles and health markers of someone in nutritional ketosis, compared to immediately after weight loss surgery when one is likely to have been fasting for at least 30 hours by the time you can eat again, if not more. Also interesting to see that the guy eating tiny meals at then end is still making potatoes a staple of his food. It certainly seems like the surgery helps, but it could be so much more effective if people were advised to try low carb first .

I went through weight loss surgery six years ago and was advised then that the order of food should always be protein (to help the body heal initially and to continue as it keeps you fuller for longer), if you have room then veg for nutrients (even though not all surgeries permit the body to absorb these, hence being on a multivitamin for life) and then, if you have room, you can have carbs. Friends of mine I have met through the support groups that are also diabetic do still use carbs to help control sugars but they had a different surgery that is less affected by sugars consumed (I had the bypass where sugar or fat can cause what is known as dumping. This is where the body reacts to the sugar or fat to such a degree that it can cause the body to go into shock that displays very much like a hypo).
Whilst I'm not considered diabetic, I do suffer reactive hypoglycaemia, which is why I joined this site (that and hubby is T2). Since having my son just over two years ago, however, this hasn't been as bad but I have just started a healthy lifestyle change and noticed that when I had a carb heavy day (as permitted on the plan) I did start feeling unwell. Lesson learned. Onward and upwards!

 

[Dark Horse]

I would like to see the long term costs to the NHS of treating a patient after the bariatric surgery.

Not just the post surgery recovery period.
Also the following decades of potential malnutrition, digestive and colon issues through fibre restriction, raised risks of osteoporosis, special food choices, etc. etc.

And then there are the complications of the surgery itself. The risk of Dumping Syndrome, infection, Reactive Hypoglycaemia... and any psychological issues before and after surgery, including adjusting relationships to food.

To claim that a single procedure costing £xxx is a one off payment that saves the NHS money in the long run is disingenuous.

The true cost/person won't be visible for decades - assuming anyone bothers to collate the data.

Generally, with cost-benefit analyses, long-term costs and benefits are factored in as far as possible. With relatively new procedures this can only be a 'guesstimate' as it takes years for hard data to be collected. There are people whose whole working life is dedicated to health economics and it is almost certain that the data will be collected and analysed.

There is quite an interesting presentation on health economics which you can find by googling "overview health economics west midlands deanery" (for technical reasons I can't post the link).

There are a number of cost benefit analyses of bariatric surgery here:- https://www.evidence.nhs.uk/Search?om=[{%22ety%22:[%22Economic%20Evaluations%22]}]&q=(qaly+or+daly+or+%E2%80%9Ccost+benefit*%E2%80%9D)+(%22bariatric+surgery%22+or+%22weight+loss+surgery%22) This one, for example, considers the costs after 20 years:- https://link.springer.com/article/10.1007/s11695-012-0679-z

 

[wood678]

I have read of people who started to do low carb to prepare for surgery, and lost so much weight so quickly and easily that they decided not to have the surgery after all - thank you very much, not now they had found out what the secret to controlling their weight had always been but they were never told it before their lives were in danger.
Low carb has been around for well over a century - but it seems to make some people crazy just to mention it.
I had a slimming club organised almost weeping over my imminent death as I explained that I was losing 2 Kg a week on Atkins.

When I did Atkins I was told how unhealthy it was and I shouldn't be eating all that fat...ooh my poor heart! What they couldn't grasp is that by eating a protein focused diet, I wasn't eating the refined sugars that had been doing eating all the wrong foods anyway. I'd gone from virtually snacking from waking to going to sleep to three proper meals a day with considered snacks in between where I felt I needed them.

 

[serenity648]

@serenity648 I was overweight before my appendix burst (14yrs old).
I had diabetes symptoms at 6yr old. My father bought me a bidet for my thrush. I had them awake through the night all through my childhood.

My B12 investigation isnt about weight or diabetes, its about fatigue and breathlessness.

 

[CherryAA]

I went through weight loss surgery six years ago and was advised then that the order of food should always be protein (to help the body heal initially and to continue as it keeps you fuller for longer), if you have room then veg for nutrients (even though not all surgeries permit the body to absorb these, hence being on a multivitamin for life) and then, if you have room, you can have carbs. Friends of mine I have met through the support groups that are also diabetic do still use carbs to help control sugars but they had a different surgery that is less affected by sugars consumed (I had the bypass where sugar or fat can cause what is known as dumping. This is where the body reacts to the sugar or fat to such a degree that it can cause the body to go into shock that displays very much like a hypo).
Whilst I'm not considered diabetic, I do suffer reactive hypoglycaemia, which is why I joined this site (that and hubby is T2). Since having my son just over two years ago, however, this hasn't been as bad but I have just started a healthy lifestyle change and noticed that when I had a carb heavy day (as permitted on the plan) I did start feeling unwell. Lesson learned. Onward and upwards!

Thanks for the info.

I hope the surgery worked for you?

I am intrigued by the way you mention sugar and fat together as causing dumping - I don't see anywhere in the literature I've read that suggests that fat follows anything like similar pathways as sugar , so its hard to see why fat would cause dumping which I've only really seen as being related to sugars. Have you been given any literature that explains the " fat " part of that comment ?

 

[CherryAA]

When I did Atkins I was told how unhealthy it was and I shouldn't be eating all that fat...ooh my poor heart! What they couldn't grasp is that by eating a protein focused diet, I wasn't eating the refined sugars that had been doing eating all the wrong foods anyway. I'd gone from virtually snacking from waking to going to sleep to three proper meals a day with considered snacks in between where I felt I needed them.

I deliberately went for high fat, the result from high risk of heart disease according to the various categorisations to a cholesterol of 3.9 - which is apparently the cut off point where the Framlingham heart study opined that the statistics show that if your total cholesterol is 3.9 or under then you do not suffer a heart attack, FULL STOP. and it doesn't matter what the make up of that is in terms of the hdl, ldl or trigs. In fact measuring any of these independently would also give me the answer - heart healthy - which is a total turn around from high risk six months ago on a low fat diet!

 

[CherryAA]

I know that bands can be removed, in fact they break and stretch (other way round?), and I thought that program was saying that even the bypass can be reversed.

whilst its reassuring to know that these operations can be reversed, i would be surprised if many people who went to the effort of having one done, then reverse them unless there are serious complications -
if you ended up slim then you are unlikely to want to stop having it because it succeeded
if you ended up still fat, then the mindset might well be, - look at how fat I am even with having had my stomach stapled, so I would be enormous without it .

whichever way you look at it, its most likely that the operation is treated as pretty well permanent for the vast majority.