Medicines And Surgery

Stomach Surgery ('Gastric bypass')

Stomach surgery may be undertaken in people with severe obesity (BMI over 40).  It is now also considered in those with less severe obesity (e.g. BMI over 35) who have medical conditions caused or made worse by the obesity (e.g. diabetes, arthritis or high blood pressure).

There are a number of different types of operation.  In effect they make you feel full sooner so you eat less, and make food pass through you more quickly.  It is a major operation requiring a general anaesthetic.

About one in 20 people who have stomach surgery may have serious problems ('complications') because of the surgery.

About one in five people develop diarrhoea after stomach surgery.  Some people develop more wind (flatulence).

Some people may need vitamin or mineral supplements because the body no longer gets all the nutrients it needs.

About 30% of people need to have their stomach surgery redone.

It is important to keep or develop a healthy lifestyle after stomach surgery.

People who have stomach surgery may expect to lose about 23 to 46kg (50 to 100 lbs) and most of this loss occurs during the first few years.

Most people keep at least some of this weight off for at least five years.

Sometimes stomach surgery doesn't work.  It is important to discuss such things with your doctor before you decide to go ahead with an operation.

Some doctors believe that more stomach surgery should be done because of the potential to help people lose weight and become more healthy.  Because of the numbers of people with obesity, stomach surgery will become more common, and techniques will improve.  As this occurs, the new information may change recommendations for when people should consider stomach surgery.

Medications

Diet pills have been used in the past in many countries.  Some of them caused unexpected and severe health problems.  These included scarring of the heart valves and damage to the blood vessels in the lungs.  Many of these medications have now been withdrawn.

Medications may help with weight loss, but they cannot be relied on alone.  It is crucial that they are combined with lifestyle changes (eating fewer calories and exercising more).  They do have side effects and their effects on weight loss are generally not great.  It is known, however, that even small amounts of weight loss that can be sustained (e.g. 5 to 10% of body weight) do improve health.  The most commonly used medications for weight loss at present are:

Sibutramine (Reductil):

Sibutramine is an appetite suppressant medication.  It works by affecting neurotransmitter chemicals in the brain. This means it makes you feel less hungry so that you are better able to stick to a dietary eating plan.

It has to be prescribed by your doctor and is usually taken once a day.  It is only recommended for those between the ages of 18 and 65 years.

If it is going to help, you will notice weight loss quite quickly (you should see at least a two kilogram loss within the first month).

Once you have lost weight, subutramine can help you to keep it off for some time.
Between 10 and 30% of people develop side effects from sibutramine which may include high blood pressure and a fast heart rate.

It is important to discuss possible side effects with your doctor.

Orlistat (Xenical)

Orlistat is a medication which stops your body from absorbing some of the fat in your food.  It is taken three times daily with food.

It must be prescribed by your doctor.  About half the people who take orlistat for a year lose 5% of their body weight (This equals about 5kg for a 100kg person).  About a third of people will lose 10% of their body weight in a year.

Orlistat can help you keep off some of the weight you lose.

Side effects of taking orlistat may include:

• Wind (flatulence).
• Faecal urgency (the sensation that you need to open your bowels urgently).
• An oily leakage from the back passage (the anus).
• Some vitamins the body are not well absorbed if you take orlistat (vitamin D, E, K and beta-carotine).  You should discuss the need for vitamin replacement with your doctor.

About 25% of people taking orlistat may have these symptoms.  They can be reduced by eating less than 30% fat in your diet.

Fluoxitine (an SSRI medication):

This is an anti-depressant medication which may reduce feelings of hunger making it easier to stick to your diet plan.  It may help you to lose one or two kilograms more than going on a low calorie diet alone.

About 20% of people feel sick when taking this medication.  Few people have serious side effects but it is important to discuss these with your doctor.