Lapband Seminar Port Lap Surgery
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Transcript of Lapband Seminar Port Lap Surgery
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Managing Obesity in Adults
“Laparoscopic gastric band surgery, a partnership in sustained weight
loss”
Recent advances in surgical treatment for obesity
69 Lake Rd, Port Macquarie NSW
Dr George Petrou BSc (Med) MBBS FRACS
www.portlapsurgery.com.au
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Obesity: Definition
• Imbalance between calorie intake & expenditure
• BMI (body mass index) = weight/height2
BMI > 25 = overweight (>50% adults)
BMI > 30 = obese (20% adults)
BMI > 35 = severe obesity (8% adults)
The most common chronic illness in the Western world
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The increase in severe obesity (USA)
Sturm R. Arch Intern Med 2003;163(18):2146-8.
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The weight problem in Australia today
NORMAL
BMI 18.5 – 24.9
OVERWEIGHT
BMI 25 – 29.9
Class I
BMI 30 – 34.9Class II
BMI 35 – 39.9
Class III
BMI 40
45% 4% 6%33% 12%
1:10 of the Australian adult community may have a BMI >35
BEACH 2003-2004 the Australian adult population data consistent with AUSDIAB data
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Health Risks and Increased Risk of Mortality
Diabetes
Hypertension
Sleep apnea
Depression
Joint pain
Infertility
Cancer
Acid reflux
Asthma
Calle EE, Michael MJ, Petrelli JM, et al. Body-mass index and mortality in a prospective cohort of US adults. N Eng J Med. 1999;341(15):1097-105.
Flegal KM, Graubard, B. I., Williamson, D.F., Gail, M.H. Excess deaths associated with underweight, overweight and obesity. JAMA. April 20, 2005 2005;293(15):1861-1867.
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High risk
Medium risk
Low risk
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Diseases Attributable to ObesityRelative Risk of Developing Certain Diseases Over the
Next Decade For Men With BMI >351
0
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Rel
ativ
e R
isk
Diabetes High Blood
Pressure
Heart Disease Stroke
1. Lopes HF, Egan BM. Autonomic dysregulation and the metabolic syndrome: Pathologic partners in an emerging global pandemic. Arq Bras Cardiol. 2006;87:489-498.
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BMI & death
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4001
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High risk
Medium risk
Low risk
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Does Weight Loss Make a Difference?
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Impact of Weight Loss on Risk Factors ~5%
Weight Loss
5%-10%
Weight Loss
HbA1c
Blood Pressure
Total Cholesterol
HDL Cholesterol
Triglycerides
1. Wing RR, Koeske R, Epstein LH, et al. Long-term effects of modest weight loss in type II diabetic patients. Arch Intern Med. 1987;147(10):1749-53. 2. Mertens IL, Van Gaal LF. Overweight, obesity, and blood pressure: the effects of modest weight reduction. Obes Res. 2000;8(3):270-8. 3. Blackburn G. Effect of degree of weight loss on health benefits. Obes Res. 1995;3 Suppl 2:211s-216s. 4. Ditschuneit HH, Frier HI, Flechtner-Mors M. Lipoprotein responses to weight loss and weight maintenance in high-risk obese subjects. Eur J Clin Nutr. 2002;56(3):264-70.
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-20
-15
-10
-5
0
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Short-term Obesity Therapy Does Not Result in Long-term Weight Loss
C
ha
ng
e in W
eig
ht
(kg)
Source: Wadden TA, Sternberg JA, Letizia KA, et al. Treatment of obesity by very low calorie diet, behavior therapy, and their combination: a five-year perspective. Int J Obes. 1989;13 Suppl 2:39-46
5-YearFollow-up
End ofTreatment
Baseline
Diet alone
Behavior therapy
Combined therapy
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Weight loss sustained with surgery!
0
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0 1 2 3 4 5 6 7 8
Dieting
Exerscise
Diet and exercise
Diet exercise and
drugs
Surgery
Year
weight loss
%
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Resolution of Diabetes: Recent Data
0%
20%
40%
60%
80%
100%
Pontiroli,
5 yr
Ahroni,
1 yr
Spivak,
1.5 yr
Ponce,
2 yr
Dixon,
1 yr
Torquati,
1 yr
Skroubis,
2 yr
Pories,
2 yr
White,
4 yr
Study
% R
es
olv
ed
RYGB
LAGB
Pontiroli AE et al. Diabetes Care. 2005;28:2703-2709. Ahroni JH et al. Obes Surg. 2005;15:641-647. Spivak H et al. Am J Surg.
2005;189:27-32. Ponce J et al. Obes Surg. 2004;14:1335-1342. Dixon JB, O'Brien PE. Diabetes Care. 2002;25:358-363.
Torquati A et al. J Gastrointest Surg. 2005;9:1112-1118. Skroubis G et al. Obes Surg. 2006;16:488-495. Pories WJ. Presented at:
NAASO-The Obesity Society Annual Scientific Meeting; October 20-24, 2006; Boston, Mass. White MA et al. Obes Res.
2004;12:949-955.
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Most Common Surgical Options
Gastric Bypass (GBP)
The LAP-BAND® System Adjustable Gastric Banding
Sleeve Gastrectomy (SG)
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The LAP-BAND ® System
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Am I a candidate for Surgery?
NORMAL
BMI 18.5 – 24.9
OVERWEIGHT
BMI 25 – 29.9
Class I
BMI 30 – 34.9Class II
BMI 35 – 39.9
Class III
BMI 40
45% 4% 6%33% 12
%
* BMI (Body Mass Index): A measurement of an individual’s weight in relation to height (kg/m2).
1:10 of the Australian adult community
BEACH 2003-2004 the Australian adult population data consistent with AUSDIAB data
Potential candidates for surgery
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How much weight will I lose?
Slow, gradual weight loss (0.5 kg per week)
60% excess weight loss in 2 years
Requires life-long commitment to change
Requires long-term follow-up
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The LAP-BAND® produces similar sustained weight loss as more
invasive surgery
%EWL
Years of Follow Up
O’Brien P, McPhail T, Chaston T, & Dixon J Obes Surg. 2006: 16; 1032-1040.
Weight loss is gradual!
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BUT HOW DOES IT WORK?
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The LAP-BAND® System Allows You to
Tame Your Hunger!
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The LAB-BAND® System acts by allowing small meals to satisfy for a long period – You can choose to eat less without becoming hungry. It “Tames Hunger” providing a tool you can
work with to allow significant weight loss
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The LAP-BAND® System Is Affordable
Private health insurance Reimburses cost of LAP-BAND device, theatre staff, time
and equipment to do operation
Reimburses most of hospital stay
There are “out of pocket” specialist fees
Can I take out insurance now? YES
BAND adjustments- $15 “out of pocket” charge per
adjustment
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Next Steps If you would like to schedule a consultation to
see if the LAP-BAND® System is appropriate
for you:
– Contact our reception (02) 6584 3268
69 Lake Rd, Port Macquarie 2444
Reception @portlapsurgery.com.au
www.portlapsurgery.com.au