Introduction

Obesity is an increasing global health problem, and one of the leading preventable causes of death. The definition of obesity taken from the NHS website is; Obesity is when a person is carrying too much body fat for their height and sex. A person is considered obese if they have a body mass index (BMI) of 30 or greater . The main problem here is that there is numerous health problems linked to obesity, therefore if Obesity is helped and reduced, it would be like solving the root to the numerous health problems it is linked to. In other words instead of tackling the health problems that are caused by obesity, you tackle obesity itself which would then in theory lead to a general decrease in obesity related health problems. This will not only be beneficial to the patients, but in this current economic climate will save the medical sector money that they would use on treating obesity related health problems.

Obesity is a medical condition in which an excess amount of body fat has accumulated within the body to an extent that it may have a harmful affect on health. This can in turn lead to reduced life expectancy and an increased risk of cardiovascular disease. The main problem here is that obesity increases the risk of many physical and mental conditions however regardless of this it is increasing and needs to be tackled. The main cause of obesity is a combination of excess food energy intake and a lack of any physical activity however there are cases when the cause is due primarily to genetics, medical reasons or psychiatric illness. In contrast increasing rates of societal level obesity is thought to be due to an easily accessible and palatable diet, increased reliance on vehicles and mechanized manufacturing.

There are three main ways obesity is being tackled, and it is these three solutions that I am going to focus on in my study.; Diet, Surgery and Drugs. The main solution I will focus on will be surgery.

Diet – Alternative to Surgery

The classic approach to tackle obesity is a low-calorie diet; this still remains the core treatment of obesity.

These diets have the best short-term benefits.

There are three types of low-calorie diets that can be distinguished:

Personalized and moderately restricted diet: This is dependant on a pre-therapeutic assessment. This diet takes into consideration the daily energy expenditure of each individual including their professional and family environment and their food habits. The desired level of caloric intake will equal to two thirds of the average energy expenditure; 1200 – 2000 calories per day. Low-calorie diet: Total caloric intake averages 800 – 1200 calories per day. This is a considerable reduction in the individuals daily intake and can not be maintained for a long period of time as the patient’s physical activity is hindered and the body is faced with nutritional deficiencies. This ambitious treatment is proposed during hospitalization. Very low-calorie diet: This is a less than 800 calorie per day diet also known as a protein diet. The medical follow up to this must be very accurate.

Cutting off the usual supply of calories the body gets causes the body to break down fat in order to supply itself with energy thus causing the patient to lose body weight. This dietary treatment is effective for short term benefits however requires a lot of dedication on the patient’s behalf.

Surgery

A laparoscopic adjustable gastric band also known as a lap band is an inflatable device made of silicone that is placed at the top of the patients stomach through laparoscopic surgery. Laparoscopic surgery also known as Keyhole surgery is a modern technique of surgery in which operations that take place in the abdomen are carried out through small incisions, usually measuring from 0.5-1.5cm. This type of surgery uses images displayed on a monitor which can be magnified. Keyhole surgery is a very beneficial and efficient procedure as the patient feels less

pain and discomfort and recovery time is considerably reduced.

Gastric banding is the least invasive surgery of its kind however it carries the usual risks of any gastrointestinal surgical operation. The patient’s intestines are not re-routed as the stomach is not staples or removed therefore the patient is able to absorb nutrients from food in a normal procedure. Gastric bands are able to stay without causing harm in the patient’s body as they are made entirely of biocompatible materials.

They way this procedure works is that the gastric band is placed on the top portion of the stomach using keyhole surgery. The placement of the band creates a small pouch at the top portion of the stomach. This pouch approximately holds about half a cup of food, in contrast to its normal six cups of food. The pouch fills up quickly; this is where the band comes into effect. The band causes food to pass slowly from the pouch into the lower part of the patient’s stomach. As the upper part of the stomach fills the brain is sent a message that the stomach is full therefore the patient’s hunger dies. This causes the patient to eat a reduced amount of food and stay full for a longer period of time thus decreasing overall caloric intake which can lead to a decrease in weight over time. As the patient starts losing weight the gastric band will need to be adjusted to ensure effectiveness and improve comfort. It is adjusted using a saline solution introduced through a small access port placed underneath the skin. To avoid damage to the port membrane and prevent leakage a specialized non-coring needle is used.

This graph has been taken from www.bmj.com and gives an overall idea of the extent to which a gastric band can help weight loss.

According to the study participants who had a gastric band lost 22% of their body weight in two years in contrast to the controls who in which only lost just 6%. This resulted in the ‘gastric band group’ to be healthier and happier.

This is one proof of evidence that shows that this type of solution to tackle obesity is highly effective.

I do not believe taking drugs alone such as AMPHETAMINES is effective as there are many side effects and there have been many cases where patients have become addicted and dependant on the drug itself therefore I do not look at this as a solution personally.

Gastric Banding I believe is the most appropriate as it shows and has been proven to considerably decrease body weight and help obesity. And being a laparoscopic surgery rather than open it has its many advantages;

Reduced chance of needing blood transfusion as haemorrhaging is reduced. Small incisions are used which reduce pain and discomfort to the patient. In addition recovery time is reduced along with less post-operative scarring Less pain due to small incisions also means that less pain medication is needed Procedure times are slightly longer however, hospital stay time is less often same day discharge. So patient can be back to everyday life more quickly and efficiently. Exposure of organs is reduced due to small incisions therefore chances of contamination and disease are reduced.

However it does come with its disadvantages;

Due to the small incisions the doctor has a limited range of motion at the surgical site. Dexterity is lost. Poor depth perception Tissue can be damaged due to tools being used rather than hands.

However I believe the advantages outweigh the disadvantages so keyhole surgery is a effective and efficient solution.

However I believe the advantages outweigh the disadvantages so keyhole surgery is a effective and efficient solution.

There are many risks that come with this type of surgery as with any type of surgical operation.

The biggest risk is from an instrument called a trocar. Injuries are caused to either blood vessels or small or large bowel. This risk is increased with patients that have a history of prior abdominal surgery.

Benefits of gastric banding compared to other bariatric surgeries.

There are many benefits of gastric banding compared to other bariatric surgeries. Mortality rates are considerably lower; 1 in 2000. Due to small incisions, keyhole surgery recovery times are very short along with a short hospital stay. These benefits can make the surgery greatly appeal to the patient as along with losing weight, the pain and overall time is small.

Bibliography

[1.5] Google images.

[2.5] Wikipedia. AS Biology CGP Revision Guide. – overall knowledge

[3.5] Dr Patrick Jordan .

[1] http://obesity_epi.tripod.com/solving_the_problem_of_obesity.htm

[2] http://en.wikipedia.org/wiki/Obesity

[3] http://www.globalissues.org/article/558/obesity

[4] http://www.nhs.uk/Conditions/Obesity/Pages/Introduction.aspx

[5] http://www.nhlbi.nih.gov/health/public/heart/obesity/wecan/healthy-weight-basics/obesity.htm

[6] http://en.wikipedia.org/wiki/Gastric_banding

[7] http://www.bmj.com/content/332/7550/1146.full

[8] http://en.wikipedia.org/wiki/Laparoscopic_surgery

[9] http://en.wikipedia.org/wiki/Trocar