Welcome to the Obesity Surgery in Scotland Website
Obesity
Obesity is increasing at an alarming rate, particularly in the Western World, where it has become something of an epidemic. It is now a major health issue worldwide and many governments, including our own, see it as a priority to try to combat the problem.
Obesity is defined and classified according to an individual’s Body Mass Index (BMI), which is calculated as follows:
BMI = weight (Kg) / [height (m)]2
The categories of obesity are as follows:
|
| Classification |
BMI (kg/m2) |
Risk of other illness |
Underweight |
< 18.5 |
Low |
Healthy weight |
18.5 – 24.9 |
Average |
| Overweight |
25 – 29.9 |
Increased |
Obesity class I |
30 – 34.9 |
Moderate |
| Obesity class II |
35 – 39.9 |
Severe |
Obesity class III |
> 40 |
Very severe |
|
Individuals with Class II and III obesity (BMI > 35) have a mortality rate at any given age double that of someone with a healthy weight (BMI 20 – 25). Many medical complications may arise as a consequence of obesity.
The relative risks of other diseases in obese adults (class I – III) is:
|
| Disease |
Relative Risk |
| |
Women |
Men |
Type II diabetes |
12.7 |
5.2 |
Hypertension |
4.2 |
2.6 |
Heart attack |
3.2 |
1.5 |
| Colon cancer |
2.7 |
3.0 |
| Angina |
1.8 |
1.8 |
| Gallstones |
1.8 |
1.8 |
| Ovarian cancer |
1.7 |
|
| Osteoarthritis |
1.4 |
1.9 |
| Stroke |
1.3 |
1.3 |
|
In the UK the problem of obesity is spiraling out of control. The prevalence of overweight and obese adults
has trebled during the past 25 years. In 2004 around two thirds of men and women are overweight or obese,
24% are obese and 2% have class III obesity, BMI > 40.
There are a number of ways to treat obesity, including diet, exercise, behaviour therapy and drug treatment
(with orlistat or sibutramine). However, surgery provides the most effective and long-lasting means of
achieving weight reduction in Class II and III obesity.
In 2006 the National Institute of Clinical Excellence (NICE) published guidelines on the management of obesity.
In individuals who have tried all other means of weight reduction, surgery is now recommended for all patients
in class III obesity (BMI > 40). When associated other illness are present surgery may be indicated in class
II obesity (BMI 35 – 39.9) after all other means of weight loss have failed. In individuals with a BMI > 50
surgery is now recommended as first line treatment as no other treatment has been shown to be effective.
Based on these guidelines on obesity surgery, it is calculated that there are about 150,000 Obesity Class III
patients potentially eligible for surgery. Many different operations have been employed for weight reduction in
the morbidly obese. The NICE guidelines 2006 advocate three procedures. These are as follows:
|
| 1. |
Laparoscopic adjustable gastric banding (LAGB)
|
| 2. |
Laparoscopic Roux-en-Y gastric bypass (LRYGB)
|
| 3. |
Duodenal switch with biliary-pancreatic diversion (DS-BPD) |
