During the presentation you will learn the advantages and disadvantages of the different surgical procedures available to you such as adjustable gastric banding, sleeve gastrectomy and gastric bypass surgery.

You’ll be able to ask questions, meet our team of surgeons and support staff and even book in for a one on one appointment to discuss your individual needs and goals.

Our next information evenings for 2012 are happening at 7:00PM in the Boardroom on Level 1 of St George Private Hospital, 1 South Street, Kogarah, NSW on the following dates

24^th April

19th June

17^th July

14^th August

11th September

9th October

^6th November

To book for any of these information evenings please call us on (02) 9553 1120 or email us at info@uppergisurgery.com.au and we will reserve your place – places are limited so contact us ASAP to make sure you don’t miss out.

This is a good opportunity to make Christmas a little bit different this year; a lot healthier this year. There is no need to feel like you’re missing out either; all you have to do is make a few minor swaps. Whenever you have control over the food on offer, always opt for the healthier alternatives.

You can still enjoy your favourite treats, after all it is Christmas, but make sure it is in moderation.  Some ways to reduce the fat content and increase the nutritional value are listed below.

• Turkey is an excellent source of protein and without the skin; it is very low in fat. For a healthier cooking method, prick the skin to allow the fat to drain out while roasting on a rack. Take care though with the added trimmings such as gravy, stuffing and sauces.
• To reduce the fat in the gravy without compromising the taste, pour the turkey juices into a jug and allow settling. Once the fat has risen to the top, carefully spoon out the fat and use the remaining juices for the gravy.
• Choose a fruit, vegetable or chestnut based stuffing instead of sausage meat. This will reduce the total fat as well as saturated fat intake. Cook the stuffing separately to avoid soaking up the fats and use wholegrain breads for an increased fibre intake.
• Serve plenty of steamed or grilled low starch vegetables such as asparagus, green beans, snow peas and brussels sprouts. They make a light addition to the roast, just make them interesting. Try wrapping grilled asparagus with a thin strip of prosciutto or tossing green beans in fat-free vinaigrette with some wholegrain mustard and chives.
• Bake starchy vegetables in a separate pan to the roast to avoid soaking up the fats and serve in small portions. Opt for baby potatoes and sweet potatoes for a lower GI alternative. Offer a variety of salads without loads of oily dressings or mayonnaise.
• Instead of the traditional prawn cocktail as a starter, try barbequing some prawns or even try baking or barbequing a whole fish. For an easy and delicious recipe, wrap a whole fish such as snapper in foil, stuff the cavities with thin sliced garlic and lemon, and drizzle the fish with the juice of lemon, balsamic vinegar and a little bit of olive oil.
• Enjoy a small portion of your favourite desert but ensure to serve some fruit as well. Make the most of the fruit in season such as peaches, cherries and apricots. All delicious on their own, so there’s no need to drown them in cream and ice cream. For a creative touch, try stone fruit baked or barbecued, with a berry sauce.

The team at Upper GI surgery wish you all a healthy and a happy festive season. Enjoy Christmas and we’ll see you all in 2012.

Portion Distortion – Smart Size, don’t Super Size.

The session will be held on February the 8th at 7PM in the Boardroom of St George Private Hospital at 1 South Street Kogarah.

This information session will enable group discussion on portion distortion and tips to smart size. You will discover techniques that lead to smarter eating and build an understanding of the food portion size needed for a successful outcome. Emotional hunger versus physical hunger, and binge eating will also be discussed.

Non Upper GI Surgery patients and those people considering weight loss surgery are welcome – please ensure you register before hand

Please contact our team on 02 9553 1120 or via info@uppergisurgery.com.au to register to attend the Support Group.

http://www.dailytelegraph.com.au/news/the-last-step-for-obese-removing-80-per-cent-of-their-stomach/story-e6freuy9-1226207024764

Featuring  quotes from Upper GI Surgery’s own Dr Michael Talbot it give’s some differing views on the for and against of the sleeve gastrectomy – Dr Talbot s view?

“One of Australia’s “sleeving” pioneers, Dr Michael Talbot, said the most serious complication is gastric fluid leaking from the staple line causing serious infection that can result in a month-long hospital stay or even death.

Lap-banding is safer and Dr Talbot warned that sleeving should only be performed on the morbidly obese in need of rapid weight loss.

“That risk varies from 0.5 per cent to 3 per cent depending on the centre where the surgery is occurring and the experience of the surgeon,” said Dr Talbot, an upper gastro intestinal surgeon at St George Public and Pri- vate Hospitals.

“If there are several hundred cases a year, statistically speaking it will happen. Whereas the risk of significant complications of a similar magnitude is one in 1000 or less with the gastric band.”

Dr Talbot said on average, patients lose 60 per cent of the extra weight they carry, or 30-40kg over 12 months.”

We asked our practice principal, Dr Michael Talbot for his view on this topic and his response was that

“The reasons are complex, but in the end it comes down to money.

While there has been a gradual increase in the understanding of obesity amongst health administrators, I suspect it will be several years before public hospital programs exist in NSW, which is currently the last Australian State to offer services to obese public patients.

While the health system spends far more money on treating complications of obesity than obesity itself, there is still a concern about how much it would cost the State Government if they allowed obesity treatments to occur in the hospitals that they run.

“Of course,” Dr Talbot went on to say, “Australia is not the only country where Obese patients are denied treatment as can be seen from this recent article from NZ.”

Why is publicly funded bariatric surgery still not fully supported?

Richard Flint, Steven Kelly

Note: Originally Published in the New Zealand Medical Journal – Reproduced here with thanks

It is incredulous that New Zealand is still debating the merits of public funded bariatric surgery, when it is close to 40 years since it was introduced.1,2 Back in the 1970s surgery was freely offered with little data justifying its efficacy.

Fortunately our surgical predecessors were right as we now know the perils of obesity; it reduces life expectancy (by 30% for every 5 kg/m2 above normal BMI),3 increases the risk of cancer,4 is responsible for an alarming rise in diabetes,5 reduces worker productivity,6 and is destined to burden the health budget by over $300 million dollars per year.7

Furthermore we now know that bariatric surgery can result in significant, long-term weight loss;8 reduce comorbidities;9 improve quality of life;10 improve mortality;11 and improve health economics;12 whilst maintaining a very safe perioperative profile.13 So why is there now a hesitancy from the non-surgical community to adopt bariatric surgery as a viable option for those who are obese?

The first argument against surgery (and often the most fervent) is that obesity is just a product of free will and resources should not be spent to surgically correct a self-inflicted condition.14 Whilst it is true that most food is ingested willingly, it is also true that factors promoting obesity are not experienced willingly.

Widespread obesogens like bisphenol-A (BPA),15 prenatal factors such as poor maternal diet that increases the risk of future obesity,16 socioeconomic status17 and heavy commercial marketing of poor quality foods are all involuntary factors that have been implicated in the development of obesity.

The ethics of denying patients the chance for surgery because they have been too weak-willed to resist in a pro-obesogenic environment must be questioned. Even if this argument is accepted then it must surely raise a perturbing precedent.

What difference would there be in denying patients treatment for melanoma because they failed to use sunscreen, retrovirals for AIDS because they failed to adopt safe sexual practises, angioplasties for coronary artery disease because they failed to exercise 30 minutes a day, or oxygen therapy for COPD because they used to smoke? Most of healthcare is focused on conditions that could be ameliorated by healthy life choices, but it is disturbing that obese patients are judged on a premorbid sense of ‘discipline’ that is never debated as a prerequisite to treatment for other conditions.

A further argument against bariatric surgery is that it does not work. Anecdotal tales of a patient pureeing up Mars (chocolate) bars to sabotage their weight loss surgery are often garnered as proof (does anyone know who this patient really is?) However, this conclusion is not supported with scientific evidence.

Randomised controlled trials18,19 and cohort studies8,20 have shown bariatric surgery to be vastly superior to dieting. Weight loss is maintained for over a decade21–25 that not only improves comorbidities but guarantees an increased survival.8,11,26 However, if we are to accept that the single anecdote of a nameless patient can be used to reject the weight of evidence supporting bariatric surgery, then why is no-one questioning therapies for other conditions.

Why do we not deny drug-eluting cardiac stents when we know that over 10% of patients will fail to continue thienopyridine therapy within the first month so increasing stent thrombosis and subsequent mortality by a factor of 10.27

Why should we maintain solid organ transplantation when up to 38% of patients will fail to take their anti-rejection medication.28 Is it because it is not acceptable to deny people an effective treatment when their survival is at risk. How much more inappropriate can it be to decline bariatric surgery that has been shown to improve annual survival by 80%!29

But maybe the main reason that bariatric surgery is resisted is the concern that health resources may be overwhelmed. Estimates that a quarter of adult New Zealanders are obese30 correlated to United States data showing rising popularity of bariatric operations31 can cause concern over cost blow-outs unless surgery is withheld. Yet not doing anything has an inherent cost.

Obesity increases the cost of inpatient and outpatient care by 36%, the cost of medication by 77%,32 and accounts for 2.5% of New Zealand’s health spending.7 This can be extrapolated to $344 million a year, yet the true cost can only be greater as this estimate is based on 1990 data that does not account for the recent rise in the rate of obesity. In the face of such sums it seems ironic that withholding surgery will actually cost the health system even more. Numerous studies have indicated that bariatric surgery leads to long-term savings33–36 with the cost of surgery being recouped within 2 years.37

In recognition of such data the Ministry of Health published a business case in 2008 for New Zealand public funded bariatric surgery.38 The recommendations that 0.5% of the morbidly obese population be offered surgery (equating to 915 operations over a 5-year time period) became closer to reality in October 2010 with the introduction of specific funding earmarked for bariatric surgery on a nationwide basis with geographical equality.39 Despite being an admirable first step toward an effective treatment for obesity, it is uncertain to guarantee the adoption of bariatric surgery as a mainstream option. The funding is temporary and reliant on District Health Boards to pick up the future costs.

Furthermore, it is difficult to see how District Health Boards will be ‘convinced’ on the utility of bariatric surgery when the results of just 13 operations a year in cities such as Christchurch are expected to influence the adverse effects of the 90,000 obese people in their district. So it is unsurprising that some have intimated that the restriction of bariatric surgery is prejudicial rather than based on a reasoned evaluation of the evidence.40

In a time when obesity has increased to near epidemic proportions, New Zealand has progressed from readily available bariatric surgery to a position of near impossible access. And this is despite the overwhelming evidence that extol the merits of such surgery. Must it take another 40 years to get back to the position we enjoyed in the 1970s?

Competing interests: Both authors are bariatric surgeons.

Author information: Richard Flint, Steven Kelly, Bariatric Surgeons, Department of Surgery, Christchurch Public Hospital, Christchurch

Correspondence: Mr Steven Kelly, Dpt of Surgery, Christchurch Public Hospital, PO Box 4345, Christchurch, New Zealand. Email: steve_kelly@clear.net.nz

References:

1.                   Burcher S, Sorrell V. Intestinal bypass for obesity. New Zealand Medical Journal. 1971;73:129.

2.                   Hanson F, Perera A. Surgery for morbid obesity in a provincial centre. New Zealand Medical Journal. 1982;95:426.

3.                   Whitlock G, Lewington S, Sherliker P, et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373:1083-96.

4.                   Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. N Engl J Med. 2003;348:1625-38.

5.                   Geiss LS, Pan L, Cadwell B, et al. Changes in incidence of diabetes in US adults, 1997-2003. Am J Prev Med. 2006;30:371-7.

6.                   Suhrcke M, McKee M, Arce RS, et al. Investment in health could be good for Europe’s economies. BMJ. 2006;333:1017-9.

7.                   Swinburn B, Ashton T, Gillespie J, et al. Health care costs of obesity in New Zealand. Int J Obes Relat Metab Disord. 1997;21:891-6.

8.                   Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741-52.

9.                   Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg. 2000;232:515-29.

10.               O’Brien PE, Dixon JB, Brown W, et al. The laparoscopic adjustable gastric band (Lap-Band): a prospective study of medium-term effects on weight, health and quality of life. Obes Surg. 2002;12:652-60.

11.               Adams T, Gress R, Smith S, et al. Long-term mortality after bariatric surgery. N Engl J Med. 2007;357:753-61.

12.               Picot J, Jones J, Colquitt JL, et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess. 2009;13:1-190, 215-357, iii-iv.

13.               Flum DR, Belle SH, King WC, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361:445-54.

14.               Puhl RM, Heuer CA. The stigma of obesity: a review and update. Obesity (Silver Spring). 2009;17:941-64.

15.               Newbold RR. Impact of environmental endocrine disrupting chemicals on the development of obesity. Hormones. 2010;9:206-17.

16.               Druet C, Ong KK. Early childhood predictors of adult body composition. Best Pract Res Clin Endocrinol Metab. 2008;22:489-502.

17.               Vieweg VR, Johnston CH, Lanier JO, et al. Correlation between high risk obesity groups and low socioeconomic status in school children. South Med J. 2007;100:8.

18.               Mingrone G, Greco AV, Giancaterini A, et al. Sex hormone-binding globulin levels and cardiovascular risk factors in morbidly obese subjects before and after weight reduction induced by diet or malabsorptive surgery. Atherosclerosis. 2002;161:455-62.

19.               O’Brien PE, Dixon JB, Laurie C, et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program: a randomized trial. Ann Intern Med. 2006;144:625-33.

20.               Buddeberg-Fischer B, Klaghofer R, Krug L, et al. Physical and psychosocial outcome in morbidly obese patients with and without bariatric surgery: a 4 1/2-year follow-up. Obes Surg. 2006;16:321-30.

21.               Scopinaro N, Marinari G, Camerini G, Papadia F. Biliopancreatic diversion for obesity: state of the art. Surg Obes Relat Dis. 2005;1:317-28.

22.               Favretti F, Segato G, Ashton D, et al. Laparoscopic adjustable gastric banding in 1,791 consecutive obese patients: 12-year results. Obes Surg. 2007;17:168-75.

23.               Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339-50; discussion 50-2.

24.               Fobi MA, Lee H, Felahy B, et al. Choosing an operation for weight control, and the transected banded gastric bypass. Obes Surg. 2005;15:114-21.

25.               White S, Brooks E, Jurikova L, Stubbs RS. Long-term outcomes after gastric bypass. Obes Surg. 2005;15:155-63.

26.               Sjostrom L, Lindroos A, Peltonem M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683-93.

27.               Spertus JA, Kettelkamp R, Vance C, et al. Prevalence, predictors, and outcomes of premature discontinuation of thienopyridine therapy after drug-eluting stent placement: results from the PREMIER registry. Circulation. 2006;113:2803-9.

28.               Germani G, Lazzaro S, Gnoato F, et al. Nonadherent behaviors after solid organ transplantation. Transplant Proc. 2011;43:318-23.

29.               Sjostrom CD, Lissner L, Wedel H, Sjostrom L. Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS Intervention Study. Obes Res. 1999;7:477-84.

30.               Gerritson S, Stefanogiannis N, Galloway Y. A portrait of health. Key results of the 2006/07 New Zealand health survey. http://wwwmohgovtnz/mohnsf/indexmh/portrait-of-health#summary. Wellington: Ministry of Health; 2008.

31.               Trus TL, Pope GD, Finlayson SR. National trends in utilization and outcomes of bariatric surgery. Surg Endosc. 2005;19:616-20.

32.               Sturm R. The effects of obesity, smoking, and drinking on medical problems and costs. Health Aff (Millwood). 2002;21:245.

33.               Ackroyd R, Mouiel J, Chevallier JM, Daoud F. Cost-effectiveness and budget impact of obesity surgery in patients with type-2 diabetes in three European countries. Obes Surg. 2006;16:1488-503.

34.               van Mastrigt GA, van Dielen FM, Severens JL, et al. One-year cost-effectiveness of surgical treatment of morbid obesity: vertical banded gastroplasty versus Lap-Band. Obes Surg. 2006;16:75-84.

35.               Craig BM, Tseng DS. Cost-effectiveness of gastric bypass for severe obesity. Am J Med. 2002;113:491-8.

36.               Jensen C, Flum DR. The costs of nonsurgical and surgical weight loss interventions: is an ounce of prevention really worth a pound of cure? Surg Obes Relat Dis. 2005;1:353-7.

37.               Cremieux PY, Buchwald H, Shikora SA, et al. A study on the economic impact of bariatric surgery. Am J Manag Care. 2008;14:589-96.

38.               Assessment of the business case for the management of adult morbid obesity in New Zealand. Wellington: Ministry of Health; 2008.

39.               Turia delighted with funding for life-saving weight-loss operations. 2010. www.beehive.govt.nz/release/

40.               Foo J, Toomath R, Wickremesekera SK, et al. Bariatric surgery: a dilemma for the health system? N Z Med J. 2010;123:12-4. http://journal.nzma.org.nz/journal/123-1311/4027/content.pdf

The theme for this meeting is “Building Relationships” .

The activity will outline the building blocks that help you to create and strengthen healthy relationships with spouses, friends, family members and work colleagues. When people go through weight loss they find others treating them differently and the objective of this session is to assist our group members to identify and work on skills that help them to facilitate their relationships.

The cost of a gastric banding procedure can often be an important decision factor for those considering it. But a recent study shows that the cost of a gastric banding procedure is offset by reductions in medical costs associated with obesity. In this study, the obesity-related medical costs of obese patients who didn’t have a gastric banding procedure continued to rise whereas for those who did have surgery medical costs declined.

Importantly, the gastric banding patients, within four years all patients had broken even financially and patients with diabetes broke even financially in 2.25 years. The study looked at healthcare claims data from over 7,000 patients who had undergone gastric banding compared with claims from a similar number of surgery-eligible people who did not have surgery. The results emphasise the important effect gastric banding can have on keeping healthcare costs down.2

So, although there is an initial financial outlay for a gastric banding procedure, the benefits in terms of reduction in healthcare costs can be significant within a relatively short period, meaning it may be a cost effective option for weight loss in eligible candidates.

To find out more about how you could benefit from a gastric banding procedure, please call one of our team members on 02 9553 1120 or drop us an email to info@uppergisurgery.com.au

So to help you along the path we are launching a regular support group and the first meeting will be on Wednesday August the 3rd at 7:00 PM in the boardroom at St George Private Hospital, 1 South Street, Kogarah.

Our theme for the first support group is “Slaying Your Dragons” and we’ll be talking about overcoming some of the major obstacles encountered after bariatric procedures.

Its a very relaxed environment and an opportunity to meet with other people who are also sharing your journey as well as an opportunity to talk in an open forum with  folks from the Upper GI team.

Our forum moderator will be Narelle Storey, one of Australia’s most experienced bariatric nurses and patient support specialists so please RSVP as soon as possible by calling one of the team on 02 9553 1120 and letting us know you’ll be coming along.

Meals should remain based on lean protein foods and free vegetables, and the addition of low Glycaemic Index (GI) carbohydrates may be useful for sustained energy release over periods of daily fasting.

Even though you are fasting from sunrise to sunset, with careful planning you can still consume 2-3 small, nutritious meals and 1 snack each day: Suhoor (just before dawn), Iftar (immediately after sunset), dinner (around 2-3 hours after Iftar), and 1 snack later in the evening.

Fluids

Use the time between your dinner meal and bedtime to sip fluids (preferably water). To help avoid dehydration throughout the day, try waking up slightly earlier each morning to allow yourself time to have a drink before/after your Suhoor meal (remembering to avoid eating and drinking at the same time).

If you regularly consume a lot of caffeine containing beverages (coffee, cola, tea), reduce intake 3-5 days before Ramadan begins to reduce symptoms of withdrawal such as headaches and irritability.

Multivitamin

It is important to continue with your multivitamin (and other supplements) during Ramadan. To prevent voiding your fast, take your multivitamin at Suhoor (and at Iftar if you have had a sleeve gastrectomy or bypass and therefore require 2 multivitamins each day).

Exercise

It may be advisable to exercise in the evening after your fast has been broken and your body has been supplied with energy from food.

Medications

If you are taking regular medications, please speak to your doctor before Ramadan as some medications may need to be changed to enable you to take it outside periods of fasting. Do not skip your medications without discussing this with your doctor.

Quick tips

• Consume 2-3 small, nutritious meals each day: Suhoor, Iftar, and dinner.

• Include 1 snack each day, preferably a piece of low GI fruit or low fat yoghurt.

• Meals should contain mostly lean protein foods and free vegetables, with a small amount of low GI carbohydrate foods.

• Remember that Iftar is a meal, not a feast and “normal” portion sizes should be consumed.

• Eat slowly and chew your food well to avoid indigestion/heartburn, nausea and regurgitation.

• Break your fast with a warm drink/soup 10- 15 minutes before eating to avoid food getting stuck

• Avoid “empty calories” such as sweets, pastries, fried foods and fruit juice. Limit sweets to 1-2 per week.

• Avoid eating and drinking at the same time. Sip between Iftar, your dinner meal and bedtime. Try rising earlier to drink before/ after your Suhoor meal. Aim for 2Lt of fluid each day.

• Continue your multivitamin. Take it at Suhoor (and at Iftar if required).

• Commence/continue Benefiber fibre supplement if you are prone to constipation.

• Continue to exercise, perhaps after Iftar.

• Speak to your doctor about your regular medications before commencing fasting.