Obesity is a chronic condition. Everyone can lose weight but maintaining weight loss is the problem and many people see their weight frustratingly yo-yo throughout their life while they battle their weight issues.
As a specialist Weight Loss or Bariatric Surgeon, I see the dramatic effects that sustained weight loss achieves but it's a tool not a magic bullet and lifestyle changes still underpin long term success. Weight loss surgery may or may not be for you but I'm happy to discuss this with you and guide you through the risks as well as the benefits.
Using Body Mass Index (BMI) isn't perfect but it does give us some guidance as to the risk to your health of your weight.National guidelines in the UK recommend that weight loss surgery is an option if your BMI is more than 40 kg/m2. The BMI cut-off is lowered to 35 if you have developed some medical condition because of obesity. But, careful thought may be given to weight loss surgery even if your BMI is between 30 and 35 (especially if you have Type II diabetes or have an Asian ethnic background, for example) as the risks to your health are higher at lower BMIs. So...
Basically, there are 3 bariatric operations that we use in the United Kingdom for weight loss: band, sleeve or bypass. All of these are performed laparoscopically (by keyhole surgery).
Based on experience, I will evaluate your individual medical requirements and the likely effects of the different surgeries for you. I will often recommend one particular operation but will, of course, take into account your preference so that the choice of operation is a shared decision.
The Roux-en-Y Gastric Bypass (RYGB) is the standard that all weight loss surgeries are measured against but it is not the 'gold standard' as there is no perfect operation. Worldwide it is the most commonly performed bariatric procedure and has been around since the 1960s.
The Sleeve Gastrectomy (LSG) is again performed laparoscopically or in a key hole fashion. It is rapidly becoming the most popular operation for weight loss due to it's simplicity.
The Mini-Gastric Bypass (MGB), is also known as the one anastomosis gastric bypass (OAGB), is very similar to the traditional RYGB. But it is a simple procedure with a shorter operating time. The key difference is that this technique involves only one join of the bowel (anastomosis) rather than two.
From being the most popular operation for weight loss in the 90s and 00s, gastric banding has lost favour. There probably is still a place for them in a select group of patients but I just don't like them, and feel that the other surgical options are better in absolutely every respect.
Regardless, although I am not keen on gastric bands I can discuss your personal situation with you. I am also very happy to adjust your band if you have had this done elsewhere or take it out!
If you have had weight loss surgery in the past, and are experiencing problems or weight regain then it may be possible to improve your situation with a ‘secondary’ or revision procedure.
Medications, Balloons and Endoscopic procedures
I have had experience in most aspects of weight loss management and I am happy to discuss these with you and advise you or refer you elsewhere if this is a path you wish to take.
I now offer intra-gastric balloons for weight loss using the Orbera 6 or 12 month balloons. I am evaluating Endoscopic Sleeve Gastroplasty and I am looking at the data for newer surgical procedures such as the SADI-S and SASI-S.
I am also keen on developing a single port sleeve gastrectomy and daycase bariatric surgery.
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