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See Dr Morton’s relief from stomach problems and living with diabetes and thyroid problems
Today was one of enormous contrast. I was in Paris, having been invited to speak and chair sessions at the 14th World Congress of Endoscopic Surgery; an international meeting attended by a broad mix of surgeons from around the globe. The day began with petit déjeuner in a café as svelte, chic Parisian ladies (and handsome well groomed men) strolled by going about their daily business. An hour later I was watching a laparoscopic gastric (stomach) bypass (keyhole obesity operation) on a lady with a BMI (body mass index: weight divided by height squared) of 100. The normal BMI range 18-25 for both men and women. The average BMI for both men and women in the UK is 27, with over ¼ of the UK adult population being classified as obese (BMI >30kg/m). By 2050 obesity is predicted to affect 60% of adult men, 50% of adult women and 25% of children.
In order to prepare for the operation she had been required to live only on a protein ‘shake’ diet for four weeks. Her weight had been recorded and had she not lost an appropriate amount of weight the procedure would have been cancelled. The goal of this diet was not weight loss, as clearly many prior attempts at dieting had failed. It was being used to soften and reduce the size of her liver ahead of surgery; as previously it was so engorged it would prevent access to the stomach.
Diabetes and high blood pressure are often corrected very quickly and the other problems improve as weight is lost
The procedure involved stapling off a small area at the very top of the stomach to make a small pouch to about the size of a golf ball. The small bowel (intestine) was then divided approximately two metres downstream. The lower end of this was then connected to the small stomach pouch by a further stapling device. The resultant effect was to produce a small stomach (that restricted the amount of food that could be received before ‘feeling full’) and the food then leaving down a piece of small intestine, the ‘alimentary limb’, two metres below where it would usually enter (thus ‘bypassing’ the remainder of the stomach and the upper two metres of small bowel). The remainder of stomach, which would still produce digestive juice, and just below this the upper small bowel (duodenum) would still receive bile and pancreatic juice (all important for digestion). These would then pass down into the now disconnected upper small bowel. This (biliary-pancreatic limb) was then re-connected to the alimentary limb two metres below the join to the stomach (making a ’Y’ shaped reconfiguration). The procedure is therefore called a Roux-en-Y gastric bypass. The operation was performed without incident by a skilled obesity (bariatric) surgeon and I am sure that the lady concerned will lose weight and do well in the future. Such people are frequently diabetic, hypertensive and often have joint and breathing problems due to the weight that they carry about their person. The diabetes and high blood pressure are often corrected very quickly and the others improve as weight is lost.
Whilst this was all very amazing, it led me to consider why this operation was being performed at all. In my current role I am not a bariatric surgeon, although have performed such procedures in the past.
The problem of obesity is one that which every doctor is now being faced. It is an epidemic and the UK has the second highest incidence of obesity in Europe (first is Hungary – I kid you not!). Not only is it affecting adults but their offspring are also becoming obese. It is not just that children sit at a computer/TV screen rather than playing sport and riding bicycles. It is also a cultural change driven by ready access to high-calorie, high-fat snacks/meals and sugary drinks. Manufacturers, and those advertising on their behalf, must have a responsibility to ensure that healthy eating and a healthy lifestyle are promoted. Also education of the population must ensure that we all have a responsibility for our own health.
Obesity truly represents the greatest threat to mankind since the Black Death
Obesity truly represents the greatest threat to mankind since the Black Death. It is a truly sobering thought that, despite the advances in modern medicine, the children of today may be the first generation on average to die at a younger age than their parents!
Whilst people like Jamie Oliver tried to ensure schools provided children with a healthy balanced diet and education about healthy eating, mothers in South Yorkshire (‘Sinner ladies’) responded by feeding their children fish and chips through the school fence. There is therefore a need to re-educate several generations about healthy eating and ensuring government, the food industry and advertisers globally act in the best interests of their electorate and customers if we are to avert this disaster. In the meanwhile there will be a continuing need for bariatric surgery and obesity will remain an enormous drain on our healthcare and social welfare budget.
Anyhow, time to get off my soap box and back to absorbing the wonder that results when a healthy lifestyle and haute couture are combined in a backdrop of historical and architectural wonder.
Au revoir
For more information on obesity surgery see BOMSS