Obesity - Obesity Problem, Obesity Cause

If you consider having a big, round tummy like the Michelin Man as the symbol of fortune, you may need to think otherwise. Obesity not only has a significant impact on your health, it is also associated with a number of chronic illnesses, including type 2 diabetes and metabolic syndrome. Currently, there are various laparoscopic bariatric surgeries available for patients suffering from morbid obesity. Together with diet control and altering the absorptive system, weight loss can be achieved with a holistic approach.

 

What is obesity?

Obesity is resulted by the deposit of excess fats in the body. This is caused by the over absorption and inadequate output of calories. In fact, many people are gaining weight every day due to binge eating, having a fatty diet and lack of exercise. You can find out whether you are overweight by calculating your Body Mass Index (BMI). The BMI is an internationally approved standard in assessing the weight of adults.

The BMI formula is: weight (kg) ÷ (height (m) x height (m))

 

Reference information:  http://www.obesitysurgery.com.hk/english.html

The information aims to provide educational purpose only. Anyone reading it should consult Surgery Specialist before considering treatment and should not rely on the information above.

 

Why do we need to treat obesity?

Why do we need to treat obesity?

Indeed, obesity does nothing to help you fit into fashionable outfits and affects your appearance and confidence. However, more importantly, it may cause many chronic illnesses that affect your health and may even be fatal.

Obesity is associated with diabetes, hypertension, heart disease, ankle degeneration, sleep apnea, hyperlipidemia, as well as menstrual irregularity and hormonal disturbances in women.

Central obesity also plays a major role in causing metabolic syndrome, which significantly increases the risk of stroke, cardiovascular diseases and diabetes. Compared with Caucasians, there are more cases of central obesity among Asians.

Diabetes is another prevalent disease among Asians and should not be ignored. It is associated with numerous complications, including glaucoma and heart diseases. However, most diabetic patients often ignore the problem of obesity, and do not consider obesity as a disease.

The problem is often left aside until they realize that medication and insulin injections are still unable to control their blood glucose levels. Many patients will then seek help from their GPs who refer them to specialists for laparoscopic weight loss surgeries.

Having a BMI of 25-29.9 means that patients are overweight, while those with a BMI over 30 are considered as obese. According to APMBSS’s recommendations, laparoscopic bariatric surgery is indicated for Asians with a BMI over 32 who are suffering from diabetes or obesity-related conditions such as hypertension, or those with a BMI over 37.

Various weight loss methods:

Exercise and dietary control are the basic fundamentals of weight loss. Under suitable conditions, certain patients could also take prescribed medication to reach a healthy weight. However, for those between ages 18 and 65 who cannot consistently lose weight even by taking medication, following nutritionists’ advice and doing exercise, as well as those with a BMI over 37, or those with a BMI over 32 who are suffering from diabetes or obesity-related conditions, laparoscopic bariatric surgery may be the way to go.

This includes laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, laparoscopic gastric plication and laparoscopic gastric bypass, as well as a procedure known as intragastric balloon. Patients under the age of 18 may also undergo the above surgeries with doctor’s approval.

Reference information: http://www.obesitysurgery.com.hk/english.html

The information aims to provide educational purpose only. Anyone reading it should consult Surgery Specialist before considering treatment and should not rely on the information above.

減重手術有效治療本港二型糖尿病兼肥胖人士

隨著本港及內地經濟快速增長，現代人飲食不均、多坐少動等不良的生活習慣衍生了肥胖症及相關的疾病，為社會造成一個沉重的健康問題。基於糖尿病和肥胖症有 著密切關系，醫學界出現了一個新名詞─ 糖尿肥胖症（簡稱糖胖症）。據統計，本港約有23%的人口有不正常耐糖量現像，若果其體重指數超過30，患糖尿病的風險就增加四倍。

輕微過重人士一般可以透過改變生活模式、運動、節制飲食及藥物治療來減輕體重，但對於嚴重肥胖人士，減重手術是目前改善體重最有效及長遠的方法，這亦是在西方國家一種較常見的手術，在亞洲亦愈趨普及。

澳洲墨爾本Monash University肥胖研究及教育中心的John B. Dixon教授最近在美國醫學協會期刊（The Journal of the American Medical Association）上公布，腹腔鏡束胃帶手術比傳統的藥物治療更有效地改善患有二型糖尿病兼嚴重肥胖人士（體重指數為30-40）的病況。最新發表 的研究證實，用減重手術控制二型糖尿病非常有效，幾乎有四分之三接受手術的患者在兩年後沒有復發。

香港中文大學（中大）醫學院自2002年引入腹腔鏡束胃帶手術，為治療本港肥胖症提供新方法。而在2005年，中大亦引入胃水球技術，為不適合或不樂意進 行外科手術的嚴重肥胖人士，或需要在外科手術前減肥以減少手術風險的人士，提供另一種選擇。唯胃水球手術是一種暫時性治療的方法，為期四至六個月，之後亦 需要將水球取出。

為進一步了解胃內水球及腹腔鏡束胃帶手術對嚴重肥胖人士在長期體重控制及糖尿病控制的成效，中大醫學院外科學系和內科及藥物治療學系最近就這兩項治療進行 研究，分析了122名接受胃內水球的病人及73名進行腹腔鏡束胃帶手術的病人，全部治療皆在沙田威爾斯親王醫院及東區尤德夫人那打素醫院進行。

接受胃內水球的病人，在六個月後取出水球。除了有28%（34人）需要再進行減重手術，其餘88人的平均體重減少約10公斤，而有約四成患者的不正常耐糖 量及糖尿病亦明顯受到控制。但是，在跟進一年半後，當中只有約三成病人能夠持續地減少一成的原本體重，其餘七成病人體重則出現反彈。

另一方面，73名進行腹腔鏡束胃帶手術的病人則能在術後持續減輕體重。病人在術後兩年平均減去約20公斤，即相當於減去35%的多餘體重。在這些病人中， 有25人有糖尿病或不正常耐糖量現像。手術後，72%患者的狀況有明顯改善，其中更有超過一半的患者（52%）不需要藥物治療。

研究總結，本港嚴重肥胖人士（體重指數超過30）患上糖尿病的風險比正常人高，腹腔鏡束胃帶手術一類的減重手術可有效減重及改善糖尿病。反之，胃內水球技術並不能達至同一治療成效。

參考資料: 中文大學
以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向外科醫生查詢，而不應單倚賴以上提供的資料。

是否肥胖,看看BMI

怎樣才算肥胖

 

世界衛生組織警告，肥胖已成為二十一世紀重要文明病！肥胖為健康之殺手，「腰圍越長、壽命越短」更是當紅的減重口號，過去對於肥胖有多種衡量標準，現在則以測定身體質量指數 (BMI)、腰圍及腰臀比為主流。以下對於你（妳）是否出現體重過重的問題，有五種評估方式︰

 

 

	評估方式	測量	範圍
1.	腰圍測量	公分	男性≧90公分（過重） 女性≧80公分（過重）
2.	腰臀圍比測量	腰圍 ÷ 臀圍	男性≧90公分（過重） 女性≧80公分（過重）
3.	身體質量指數　(BMI)	體重（公斤）÷ 身高平方（公尺）	BMI＜18.5（體重過輕） 18.5≦BMI<24（正常範圍） 24≦BMI＜27（體重過重） 27≦BMI＜30（輕度肥胖） 30≦BMI＜35（中度肥胖） 35≦BMI＜40（重度肥胖） 40≦BMI＜50（病態性肥胖） 50≦BMI（超級肥胖）
4.	身體脂肪測量	身體脂肪儀器	男＞25%（過重） 女＞30%（過重）
5.	國人理想體重計算方法	男性：[身高(公分)－80] × 0.7 女性：[身高(公分)－70] × 0.6	大於20%（肥胖） 大於10–20%（體重過重） 介於±10%（正常範圍） 小於10–20%（體重過輕）

 

資料來源:   www.antifat.tv

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，

應向自己的外科醫生查詢，而不應單倚賴以上提供的資料。

Five-Year Data: Surgery Betters Medical Therapy for Diabetes (Part 3)

Gastric Bypass Has the Best Risk/Benefit Profile

Regarding surgery, there were no major long-term complications or mortality after surgery, according to Dr Rubino.

Patients who underwent biliopancreatic diversion did experience more nutrient-deficiency side effects, however, including osteoporosis and osteopenia.

"The nutritional side effects of gastric bypass were both milder and less frequent by comparison," reported Dr Rubino. "For this reason, we suggest that despite the greater percent of stable remission of hyperglycemia after biliopancreatic diversion, gastric bypass has a better risk-to-benefit profile."

He acknowledged that the study was small but noted that the findings suggest that surgery might reduce future complications of diabetes.

"Five years of remission or optimal glycemic control should have a lasting impact on a patient's risk to develop diabetes-related complications."

Weight Loss Is Not the Whole Story

In their discussion, Dr Mingrone and colleagues observe that weight loss alone cannot explain the effects of surgery on diabetes in their study.

Indeed, "when we looked at the two groups of surgical patients, we found that those with sustained remission had [lost] the same weight as those who relapsed," said Dr Rubino.

A statistically significant difference in remission rates between gastric bypass and biliopancreatic diversion was also evident, but there was no difference in weight loss between these two procedures, either.

"This suggests that weight change does not tell the whole story," he added.

It is thought that gastrointestinal surgery activates weight-independent mechanisms of diabetes control, possibly hormonal. The differences in anatomy resulting from different surgical procedures are thought to explain at least some of the variance in clinical effectiveness resulting from these operations.

These observations imply that bariatric surgery should not be reserved only for obese patients with a BMI over 35 kg/m2. Dr Rubino pointed out that "diabetes surgery should be based on disease-specific criteria; BMI is not one of those."

Ultimate Question Is Whether Bariatric Surgery Reduces Deaths

In conclusion, and acknowledging that surgery for type 2 diabetes is safe and effective in terms of glycemic control and reduced diabetes complications, Drs Pournaras and le Roux note in their editorial that "the ultimate question is whether diabetes surgery is associated with reduced mortality."

"Extension of follow-up in the trials already done and future well-designed and appropriately powered studies will provide some much-needed answers," they conclude.

The authors and editorialists declare no relevant financial relationships.

Lancet . 2015;386:964–973, 936–937. Abstract, Editorial

Reference information: www.medscape.com
The information aims to provide educational purpose only. Anyone reading it should consult Surgery Specialist before considering treatment and should not rely on the information above.

    

Five-Year Data: Surgery Betters Medical Therapy for Diabetes (Part 2)

First to Compare Bypass Surgery and Medical Treatment for 5 Years

The open-label, randomized controlled trial is the first to compare gastric-bypass or biliopancreatic-diversion surgery with medical therapy with follow-up of 5 years.

Previous trials with gastric-bypass surgery and another bariatric surgical procedure that is rapidly gaining ground, laparoscopic sleeve gastrectomy, have shown that there is benefit in type 2 diabetes, but only to 3 years maximum.

However, a recent retrospective analysis of sleeve-gastrectomy procedures has revealed weight regain and a decrease in remission rates for type 2 diabetes at 5 years' follow-up.

"The 5-year mark is important because it provides a measure of durability of remission while also allowing a look at other aspects that are not assessable over the short term — for example, quality of life or disease-related complications," explained Dr Rubino.

The current single-center study was carried out at Catholic University, Rome, Italy. Participants had a body mass index (BMI) of at least 35 kg/m2, were aged 30 to 60 years, had a history of type 2 diabetes lasting at least 5 years, and an HbA1cconcentration of 7.0% or more (≥53 mmol/mol). The majority of patients had previously received medical treatment, with many on insulin.

Of the 60 patients included in the study, 20 were randomly assigned to receive medical therapy (glucose-lowering drugs, insulin, and glucagonlike peptide-1 [GLP-1] agonists); 20 to Roux-en-Y gastric-bypass surgery; and 20 to the biliopancreatic-diversion procedure. The vast majority (88%) completed 5 years of follow-up.

The primary end point was the rate of diabetes remission at 2 years, defined as a fasting glucose concentration of 5.6 mmol/L or less and HbA1c concentration of 6.5% or less (≤47.5 mmol/mol). Importantly, patients were required to achieve this without active drug treatment for at least 1 year (2009 ADA definition of remission).

Patients were assessed annually for durability of diabetes remission (up to 5 years), overall glycemic and metabolic control, cardiovascular risk, medication use, quality of life, diabetes-related complications, and long-term surgical complications.

Five-Year Remission Postsurgery Is 50%, but Long-Term Follow-up Key

Diabetes remission at 5 years was seen in 19/38 (50%) of the surgical patients without any medication. Of these patients, seven of 19 [37%] were in the gastric-bypass group and 12 of 19 [63%] in the bilipancreatic-diversion group.

None of the 15 patients in the medical-treatment group achieved remission at 5 years.

And of those patients who received only metformin to achieve an HbA1c concentration below 7.0%, the proportion of surgical patients with major improvement of diabetes from baseline rose to over 80%, according to Dr Rubino.

"Remarkably, while almost 50% (47%) of surgical patients required insulin prior to surgery, alone or in combination with multiple other agents, all but one did not require insulin 5 years after surgery," he added.

A total of 15/34 (44%) patients (53% of gastric-bypass and 37% of biliopancreatic-diversion patients) who achieved 2-year remission with surgery later relapsed with hyperglycemia, but they maintained a mean HbA1c of 6.7% at 5 years with just diet and either metformin or no medication.

"The relapse of hyperglycemia, albeit mild, in almost half of the patients with initial remission, underscores the need for continued long-term monitoring of glycemia in all patients after surgery," stressed Dr Rubino.

Two patients on medical therapy, unable to achieve adequate control of glycemia despite taking multiple drugs and/or insulin for over 2 years, requested crossover to surgery, following which they immediately entered remission.

Dr Rubino pointed out the dramatic reduction in the total number of antidiabetes and cardiovascular medications in the surgical patients over the total 5 years, adding, "This has implications for cost-effectiveness."

In surgically treated patients, there was also a greater improvement in quality of life compared with the medically treated group, and the rate of diabetes-related complications was also lower.



"Five major diabetes-specific complications were observed in the medical group, including one death from heart attack, compared with only one in the gastric-bypass group and none in the biliopancreatic-diversion group," he noted.

(Continue....)

Reference information: www.medscape.com
The information aims to provide educational purpose only. Anyone reading it should consult Surgery Specialist before considering treatment and should not rely on the information above.

     

      

Five-Year Data: Surgery Betters Medical Therapy for Diabetes (Part 1)

Bariatric surgery is more effective than medical treatment alone for the long-term control of type 2 diabetes in obese patients, finds the first 5-year follow-up study, prompting a call for a rethinking of the diabetes care pathway with more emphasis on surgery.


Overall, 50% of patients who underwent surgery showed sustained remission of type 2 diabetes (defined as HbA1c less than 6.5%) without any medication upon 5-year follow-up, compared with none in the medically treated group.


"These people had nondiabetic glycemia for 5 years without ever taking a single antidiabetic drug," said Francesco Rubino, MD, senior author of the study and chair of bariatric and metabolic surgery at King's College London, United Kingdom.


And over 80% of surgically treated patients maintained the American Diabetes Association's (ADA's) treatment goal of HbA1c concentration below 7.0%, with just diet and/or metformin.


"This is a spectacular result," added Dr Rubino, although he acknowledged that the study involved only a small number of patients and was conducted at a single center.


The results were published in the September 5 issue of theLancet by Geltrude Mingrone, MD, of the Catholic University of the Sacred Heart, Rome, Italy, and colleagues, including Dr Rubino.


Like Cancer Treatment, Surgery Should Be Option in Diabetes


In an accompanying editorial, two other bariatric surgeons, Dimitri Pournaras, PhD, MRCS, and Carel le Roux, MBChB, PhD, both from Imperial College London, United Kingdom, draw a parallel with multimodal cancer treatment, where the best surgical treatment combined with the best medical treatment is better than either alone.


"This model could be followed for diabetes, with use of best medical care to maintain remission, which is often only possible with surgery," they write.


They suggest that future randomized controlled trials should assess the optimal point at which to use surgery, but that "all surgical groups should receive intensive medical treatment and close follow-up at some stage because, as [Dr] Mingrone and colleagues have now shown, not doing so results in relapse of diabetes."


Dr Rubino concurred, noting that the management of type 2 diabetes could come to resemble that of cardiovascular disease, with treatments ranging from diet and exercise, to drugs, to endoluminal stents or surgical bypass.


"Introducing surgical treatment in diabetes management allows escalation" of therapies according to disease severity and enables risk stratification, he told Medscape Medical News in an interview.





"If you know that surgery is an option, you give diet and drugs a reasonable time to work; if they fail, surgery should be considered," he added.






(Continue....)

Reference information: www.medscape.com
The information aims to provide educational purpose only. Anyone reading it should consult Surgery Specialist before considering treatment and should not rely on the information above.