• Guest - w'd love to know what you think about the forum! Take the 2025 Survey »

Obesity Survey

Status
Not open for further replies.
Thirsty said:
Fizz, could you point me in the direction of the relevant research regarding the success of surgery in treating obesity? I ask because I know a couple of people who have gone through the procedure, lost a lot of weight, and then regained all of it and more within a few years. (I'm aware that two cases aren't particularly significant.)
Click to expand...

http://www.nice.org.uk/usingguidanc...determininglocalservicelevels/Assumptions.jsp

- Padwal R, Li SK, Lau DC. Long-term pharmacotherapy for overweight and obesity: a systematic review and meta-analysis of randomized controlled trials. Int J Obes Relat Metab Disord 2003;27(12):1437-46.
- Derosa G, Cicero AF, Murdolo G, Piccinni MN, Fogari E, Bertone G, et al. Efficacy and safety comparative evaluation of orlistat and sibutramine treatment in hypertensive obese patients. Diabetes Obes Metab 2005;7(1):47-55.
- Glenny AM, O'Meara S, Melville A, Sheldon TA, Wilson C. The treatment and prevention of obesity: a systematic review of the literature. Int J Obes Relat Metab Disord 1997;21(9):715-37.
- Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292(14):1724-37.
- Torgerson JS, Sjostrom L. The Swedish Obese Subjects (SOS) study--rationale and results. Int J Obes Relat Metab Disord 2001;25 Suppl 1:S2-4.
- Silecchia G, Perrotta N, Boru C, Pecchia A, Rizzello M, Greco F, et al. Role of a minimally invasive approach in the management of laparoscopic adjustable gastric banding postoperative complications. Arch Surg 2004;139(11):1225-30.
- Sjostrom L, Narbro K, Sjostrom CD, Karason K, Larsson B, Wedel H, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007;357(8):741-52.
- Pories WJ, Swanson MS, MacDonald KG, Long SB, Morris PG, Brown BM, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 1995;222(3):339-50; discussion 350-2.
- Ells LJ, Macknight N, Wilkinson JR. Obesity surgery in England: an examination of the health episode statistics 1996-2005. Obes Surg 2007;17(3):400-5.
Click to expand...

This is a quick paragraph from my own work with references

A Cochrane review in 1997 illustrated that bariatric surgery was an effective intervention for obesity, demonstrating good results in evidence (13). In contrast to the bleak long term results obtained by dietary and pharmacotherapy treatments bariatric surgery has been shown to result in excess weight loss of over 61% in a meta-analysis (14) which was sustainable at 10 – 15 year follow up. The ‘Swedish Obese Subjects’ study compared surgical, pharmacological, and lifestyle alteration therapy, demonstrating a tenfold increase in the success of surgical intervention compared to non surgical after 10 years (15-17).

13. Glenny AM, O'Meara S, Melville A, Sheldon TA, Wilson C. The treatment and prevention of obesity: a systematic review of the literature. Int J Obes Relat Metab Disord 1997;21(9):715-37.
14. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292(14):1724-37.
15. Torgerson JS, Sjostrom L. The Swedish Obese Subjects (SOS) study--rationale and results. Int J Obes Relat Metab Disord 2001;25 Suppl 1:S2-4.
16. Sjostrom CD, Peltonen M, Wedel H, Sjostrom L. Differentiated long-term effects of intentional weight loss on diabetes and hypertension. Hypertension 2000;36(1):20-5.
17. Silecchia G, Perrotta N, Boru C, Pecchia A, Rizzello M, Greco F, et al. Role of a minimally invasive approach in the management of laparoscopic adjustable gastric banding postoperative complications. Arch Surg 2004;139(11):1225-30.
Click to expand...

Disclaimer: - Please feel free to read the obove references and draw your own opinions, but note that I'm still only a medical student and am in no way giving medical advice

Thanks ... Fizz
 
Somewhere in Us literature, there's an ongoing survey of people wwho have lost weight and kept it off. I can't remember its title. It is the minority thing, because most dieters reert to their old eating habits and I'd disagree with fizz that it's a set point caused by hunger. Most dieters have never experienced Real hunger. it's just "the munchies" .
I know I get the munchies, but pretty much never feel hungry. We need to learn to tell the difference.
 
Interesting debate... I am in a category to be able to get bariatric surgery on the NHS but it has never been an option for me so far. Someone asked me if I ever would have gastric bypass and the answer is I'm not sure. Without looking into the ins and outs more including lifelong dependence on supplements, body dysmorphic aspects, psychological aspects and physical/recovery aspects I can say it isn't appealing. At this moment if I was told my diabetes would be cured if I had the surgery, I would seriously consider it. But for weight loss, the answer is no.
 
hanadr said:
Somewhere in Us literature, there's an ongoing survey of people who have lost weight and kept it off. I can't remember its title.
Click to expand...
If you look hard enough you can usually find a study to show most things. This is why systematic reviews and meta-analysis are important. These are independent reviews of all available evidence drawing conclusions based on many papers. There are two in the above links. Next in the order of credibility is the random control trials (RCTs)

hanadr said:
I'd disagree with fizz that it's a set point caused by hunger. Most dieters have never experienced Real hunger. it's just "the munchies" .
I know I get the munchies, but pretty much never feel hungry. We need to learn to tell the difference.
Click to expand...

I think the munchies are one end of the spectrum of hunger. If your satiety cenres were active the thought of munching would be off-putting. Food brings no pleasure when the satiety centre is active. Try ignoring the munchies and it will soon turn to hunger.

Right, I'm going to have to ignore you all again, I've two days left to finish this and I'm procrastinating as usual. I love this forum, it's pretty stimulating to talk to you all, and I've mentioned it in my acknowledgements.

Speak soon ... fizz
 
When you have a moment, Fizz, have a think about this too.
When I visited the diabetes clinic the time before last, I got chatting to the Chief DSN about the standard dietary advice on offer. I described how I had achieved my weight loss, and kept it off these past 8 years. She was very positive about it. I offered to do a presentation to their obese patients who were being considered for bariatric surgery. She said 'Great!, But I will have to clear it with Dietetics first.'
By email the following day, she told me that following her chat with Dietetics, she had been informed that my offer was 'Not appropriate.'
In other words, bariatric surgery was considered a better option for those patients than carbohydrate restrition.
Frankly, I was shocked that a condition which was accepted as a result of a poor diet could not be rectified by a correction of that diet. It struck me as an admission of defeat that bariatric surgery was considered to be the only real treatment option available.
How has it come to this?

fergus
 
Fergus - are you seriously suggesting that you are now going to become an expert on bariatric surgery too.

The type of pts who are considered have tried everything and prob low carb too. They get a lot of counselling from experts not someone dragged of the street . If the nhs is doing this I am seriously worried.

I have a few private clients who have had the surgery and it is not easy to deal with . But the wt loss is huge . Most pts who are considered for this are morbidly obese.
 
Anyone who has achieved the "impossible" should be considered an asset since teaching and education of diets and nutrition still isn't what it should be. Giving a talk and perhaps delaying or cancelling a major operation should be considered as a bonus surely and taken as a valid option. Exptions deduced of course. I could get gastric bypass on the NHS but will not even consider it as an option due to other risk factors involved.
 
graham - do you really think that HCP would just pull in anyone to talk to pts. Those considering bariatric surgery have tried everything - and that will include low carbing.
 
Isn't Fergus a healthcare pro himself?

I have tried it all, and a lot of the time we are very good at making excuses too... And not being truthful about what and how much we eat. I know people who consider crisps as nothing to eat...
 
no saz fergus is a knowledgable diabetic but he is not a HCP.

Bariatric surgery is not something that is easy to get - people have alot of couselling and having someone talk to them about low carbing is completely inappropriate . They have complex problems and actaully someone telling them how well they have done would probably be counter productive. Most would probably not want to be part of a group session - they require one to one help.

The comment about crisps is spot on.
 
Actually that isn't my experience. I have been offered surgery without me even asking about it... No counselling etc or dietitian advice so...
 
graham - if that was directed at me most people who I have seen who are that overwt are consuming massive amounts of food - 8000 calories upwards is not uncommon - but hey calories dont matter do they - or maybe they do !

And the record for crisps is 19 packets a day - - prob around 3000 calories a day ! Pt of mine!
 
Well I can beat that, I have had 24 walkers plus 2 big bags of sensations in my hey day... That is my point exactly, no control, just food. And then the surgery isn't the answer since you may lose a lot of weight but it can be gained back in the future since these people's minds often don't change...
 
Absolutely not, I work in operating theatres and really don't fancy an anesthetic. Plus I like my food and meals too so should find the motivation to do something myself and not take the offered fire escape... :wink:
 
I thought at the time that the DSN I spoke to was very open minded, prepared to think rationally about the situation, and explore solutions that had worked for other patients. At the time I don't think I appreciated how brave she was to break ranks from the standard dogma and look beyond the only available treatments.
I thought it was interesting that the dietetics dept. were the ones who decided carbohydrate restriction was considered a more extreme option than bariatric surgery.
Anyway, let's not derail what, until recently, has been a very informative thread.

fergus
 
I don't diss the idea for everyone at all but I think many people take it as an escape and not having to do the hard work. I see so many people who never thought it would be so unpleasant and painful and what all the implications actually are with any surgery at all, never mind with bariatrics... But I assume the management of the patient varies by area too, some probably get more education than others.
 
saz1 said:
I could get gastric bypass on the NHS but will not even consider it as an option due to other risk factors involved.
Click to expand...

Wow, this thread has come alive. I'll make a few comments while I drink my morning green tea.

The risk of surgery is often used as a reason to not consider it. I've come across many similar comments like "I want to be lose weight but I'm not risking my life in surgery to do so".

What is not being considered here is the risk of not doing the surgery. This is the basis of all medical decisions, only when the risk of not treating is higher than the risk of treating do we advise treatment.

Sadly, having a BMI > 40 (or 35 with co-morbidities) is dangerous. It is far more risky to not have the surgery. Do you know that if you are 40 with a BMI of 40 you have already lost 8-12 years of life?
 
Status
Not open for further replies.
Back
Top