Obesity education campaign 2017 by Mediaplanet UK&IE

JUNE 2017

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Obesity Education

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“BARIATRIC SURGERY

gave my obesity the needle” says bariatric surgery patient, Bob Joyce P4 CAROLINE CERNY

discusses the UK’s rising obesity epidemic P2

PHOTO: SHAW SOMERS

Shaw Somers on the health benefits of bariatric surgery P4

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IN THIS ISSUE

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‘Fat but fit’? There’s no such thing: University of Birmingham researches. P7

Diabetes cases have doubled since 1997: are very-lowcalorie diets the answer? P6

Obesity on the Mind: The relationship between obesity and mental health. ONLINE

Tackling the UK’s growing obesity epidemic

If the NHS is going to survive, the problem of obesity needs political attention now, say obesity experts “Doing nothing about obesity – that’s not an option,” believes the Obesity Health Alliance, which has called on the next government to get to grips with the problems associated with obesity. “With NHS funding already so stretched, spending more on ill health associated with obesity, such as type 2 diabetes, cancer, heart and liver disease, can only mean cuts in other areas of healthcare and that affects us all; it makes obesity everyone’s problem.” Latest figures on the extent of obesity in this country make clear the need for immediate action:

as obese with two thirds falling under the overweight or obese category.

when they start school, rising to more than one in three by the time they leave primary school

■ In just one year obesity was impli-

Caroline Cerny, from the OHA, says: “In today’s obesogenic environment, unhealthy food choices have become an automatic and unconscious decision. We are continually steered towards larger portion sizes, foods with a higher sugar content and we are bombarded with adverts for junk food on TV and online. “It’s not as simple as just telling people to eat less; we all live in an environment where it is hard to make healthy choices. We need the government to play a role: it can’t be left to individuals just to get on with it.”

cated in 525,000 NHS hospital admissions. Treating obese patients is estimated to cost the NHS at least £5.1 billion a year, equivalent to the salary of 165,000 nurses or 85,000 hospital doctors or the cost of 116,000 heart transplants or nearly 730,000 hip replacements, according to the OHA, which represents over 40 health organisations and charities.

■ Over one in four (27%) of the popu-

■ Currently more than one in five

lation of England are now classed

children are overweight or obese

MediaplanetUK

Caroline Cerny Alliance Lead, Obesity Health Alliance

“Treating obese patients is estimated to cost the NHS at least £5.1 billion a year.”

@MediaplanetUK

Project Manager: Rachael Sammut E-mail: rachael.sammut@mediaplanet.com Content and Production Manager: Kate Jarvis Business Developer: John Critchley Digital Manager: Chris Schwartz Content and Social Editor: Jenny Hyndman Designer: Juraj Príkopa Managing Director: Alex Williams Mediaplanet contact information: Phone: +44 (0) 203 642 0737 E-mail: info.uk@mediaplanet.com

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National Harbor, Maryland (Washington, D.C.) Gaylord National Resort & Convention Center 201 Waterfront Street, Oxon Hill, Maryland Pre-conference events: Sunday, Oct. 29 – Monday, Oct. 30, 2017 Scientific Sessions: Monday afternoon, Oct. 30 – Thursday, Nov. 2, 2017 ObesityWeek is the largest, international scientific and educational event offering the unique ability to explore the full scope of obesity from basic science to clinical treatment. Attendees learn about cutting-edge obesity research and treatment from basic scientists, neuroscientists, behaviorists, clinicians, surgeons, epidemiologists, policymakers and more.

Visit ObesityWeek.com for more information and resources Registration for ObesityWeek opens in June Use promo code USENDO and receive $20 off

Future meeting dates: 2018 – Music City Center, 201 5th Ave S, Nashville Pre-conference events: Sunday, Nov . 11 – Monday, Nov. 12, 2018 Scientific Sessions: Monday, Nov. 12 – Thursday, Nov. 15, 2018

2019 – Mandalay Bay Resort & Casino, 3950 S Las Vegas Blvd, Las Vegas Pre-conference events: Monday, Nov. 4, 2019 – Tuesday, Nov. 5, 2019 Scientific Sessions: Tuesday, Nov. 5, – Friday, Nov 8, 2019

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INSPIRATION COLUMN

Bob Joyce National Chairman, Britsh Obesity Surgery Patient Association

Bariatric surgery gave my obesity the needle

Obesity shows an appetite for surgical weight loss By Ailsa Colquhoun

By Ailsa Colquhoun

Weight loss surgery offers obese patients a kick-start to losing weight, enabling them to transform their lives through better health and wellbeing

ob Joyce, 73, is a walking example of how weight loss surgery works. Following his gastric bypass six years ago he has shed almost half of his pre-op weight of 23 stone. He now weighs in at 12 stone, a normal weight for his five feet four frame. He describes his operation as life-changing. Obesity-related conditions such as type two diabetes, high blood pressure, sleep apnoea, severe joint pain, and high blood cholesterol are now history, and he has reduced his daily tablet count from around 25 a day to one. He’s fit enough now to go on holiday without special assistance to board a plane and without anyone staring at the extender to fasten his seatbelt.

Types of bariatric surgery Bob’s operation is one of the more common bariatric surgeries available to people classed as obese (those whos body mass index is at least 35). Designed to reduce the patient’s appetite, a gastric bypass involves joining the top part of the stomach to the small intestine. Other common surgeries include inserting a gastric band, which reduces the stomach’s capacity, and a sleeve gastrectomy, where some of the stomach is removed. Today, Bob chairs the British Obesity Surgery Patient Association, which offers pre and post-operative psychiatric support to bariatric patients, including tips on life-long dietary changes. “Weight loss surgery is a great tool to help you make the right lifestyle choices, but it’s only that. 90 per cent of the results are down to you, so it really should be seen as just the start of the process.”

Surgeons may not fully understand how bariatric surgery works, but they know that it does. Surgery provides hope for an end to the UK’s rapidly growing obesity epidemic

“The current scientific thinking is that it changes the way the stomach communicates with the brain”, says Shaw Somers, President of the British Obesity and Metabolic Surgery Society (BOMSS), and a private bariatric surgeon at Streamline Surgical. “The stomach is not just a dumb tube that digests stuff. In fact, it’s a complex communication centre. “After surgery we see changed activity in the brain’s addiction centres and increased activity in its satisfaction centres. After surgery, patients find they simply don’t want to eat; that the voice that says ‘eat’ has gone.” Latest data on the number of operations carried out to treat obesity show that, in just three years, British surgeons carried out around 18,283 bariatric operations. The data shows that over three-quarters of operations were funded by the NHS.

Safe and effective Bariatric surgery is considered

a safe and effective answer to the obesity epidemic facing the UK. Survival rate for surgery is over 99.9% and within one to three days, patients can go home. This is considered all the more impressive given the increasing weight and illness of patients being sent for surgery. At the time of surgery, the average patient has an average BMI of 48.8, almost twice an adult’s ideal weight. Over half (53.9%) of men

Shaw Somers President of the British Obesity and Metabolic Surgery Society (BOMSS)

and 41.4% of women also have a high level of co-existing obesity-related disease – usually at least three conditions each. Typical problems include type 2 diabetes and sleep apnoea, or functional impairment that is so severe that people cannot climb three flights of stairs without resting. Yet, one year after surgery,

on average, patients have lost 58.4% of their excess weight and most are enjoying much improved health; well over half of patients can once again climb three flights of stairs without resting and patients medicating for sleep apnoea and type 2 diabetes are able to stop all treatments.

Avoiding expensive illhealth “This has important implications for the NHS”, says Somers: “These conditions are seen in people in their 30s and 40s who will have decades of being ill; people with diabetes, for example, can face years of worsening health. Their health and quality of life is impaired and the cost to the public purse is very high.” But, despite its successes, surgeons are clear that, in itself, bariatric surgery is not enough to secure life-long weight loss. Somers says: “It isn’t a quick fix. Surgery is just a tool to help people understand their relationship with food and that obesity is the result of this not working. The reasons why people overeat are complicated – and that’s why successful surgery is always supported by an ongoing package of care from specialists in dietetics and psychology.”

COMMERCIAL FEATURE

Spatz gastric balloons provide hope for overweight and obese people By Ailsa Colquhoun

A simple, non-surgical procedure to fit a Spatz adjustable gastric balloon can improve your chances of losing weight for longer, and give you back the body you want

For the past 30 years, gastric balloons have been used as a clinically-accepted tool in reducing excess weight. Since 2012 approximately 27,000 people have benefited from new adjustable gastric balloon technology, achieving more weight loss over a longer period of time. Adjustable gastric balloons are suitable for overweight and obese people with a body mass index of 27 and over, who have failed to achieve adequate weight loss with diet and exercise. In a process lasting just 15 minutes, a gastric balloon is

placed into the stomach through the mouth with the help of a gastroscope, a long thin tube-like device. Once in situ, the balloon is filled with fluid (saline). Generally, patients can be back home after about an hour. Gastric balloons help people to lose weight simply by taking up space in the stomach and by slowing down stomach-emptying, which maintains a full feeling for longer. However, unlike conventional balloons, the Spatz3 adjustable balloon can be inflated or deflated to suit the patient’s needs and is approved for 1 year implantation which is twice as long as standard balloons, according to Spatz Medical adjustable balloon company founder and US board-certified gastroenterologist Dr Jeffrey Brooks. As a result of these technological

advancements, 80 per cent of patients fitted with an adjustable balloon will lose at least 10 per cent of their bodyweight, compared to 45 per cent with conventional bal-

loons; at two years after balloon removal, this weight loss is maintained in 76 per cent of Spatz patients, compared to 38 per cent with a conventional balloon. The medical risks of obesity, and the benefits of weight loss, are welldocumented. Dr. Brooks also noted the social stigma against the obese as a motivating factor for some patients considering the procedure. The Spatz3 adjustable balloon is only available privately in the UK. While evaluating the cost of the procedure, Dr. Brooks encourages people to “remember to factor in the potential healthcare cost savings you will realise when your overall quality of life improves as a result of weight loss.” Find out more via info@spatzmedical.com or spatzmedical.com

COMMERCIAL FEATURE

Apollo Endosurgery fills the gap in bariatric therapy By Ailsa Colquhoun

Apollo Endosurgery endobariatric therapies (EBT) provide a costeffective solution for patients who need more than exercise, diet or drugs to lose weight

For over 20 years Apollo Endosurgery has recognised the demand for non-surgical weight loss therapies, and in its specialist medical device portfolio has the Orbera® intragastric balloon and the OverStitch™ endoscopic suturing system. Worldwide, over 220,000 patients received an Orbera® intragastric balloon. Results show that on average Orbera® patients achieve more than three times the weight loss than with diet and exercise alone and when treatment is combined with dietary and psychological support. This teaches patients healthy habits that will

help keep the weight off even after the balloon is removed. According to Mr Ahmed R Ahmed, a consultant in upper gastrointestinal and bariatric surgery at Imperial College Healthcare NHS Trust, candidates for endobariatric therapy (EBT) fall into three main types: ■■ Those who do not fit the eligibility criteria for bariatric surgery, either because they are too light or too heavy ■■ Those who are unwilling to put themselves through the rigours of invasive surgery ■■ Those who need to lose weight in order to be eligible for non-obesity related treatment, eg IVF or knee surgery A revolutionary endoscopic device, the Apollo OverStitch™ system can be used to deliver endoscopic sleeve gastroplasty (ESG), a minimally invasive procedure providing stomach volume reduction

Ahmed R Ahmed Consultant in upper gastrointestinal and bariatric surgery at Imperial College Healthcare NHS Trust

without any surgical removal. ESG patients can expect to achieve a 20 per cent weight loss at 2 years, which Mr Ahmed says is “way better than with dieting”. OverStitch™ can also be used to revise

an earlier bariatric intervention, a gastric bypass for example, where a structural problem has occurred. In the bariatric treatment market Orbera® and OverStitch™ fill an important therapeutic gap between non-surgical and surgical weight treatment pathways. According to Mr Ahmed this “allows surgeons to do more for patients who require more than drug therapy and dietary advice”. He continues: “People usually will have spent many years and many thousands of Pounds on lifestyle changes, diets, personal trainers. They will be waging a constant battle against excess weight and, yet, will still not have seen longterm sustainable results. In these patients EBT offers a truly cost-effective solution.” Read more at apolloendo.com/

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INSIGHT

VLCDs: the ‘new’ weapon in the war against type 2 diabetes

While very-low-calorie diets have been associated anecdotally with reversal of type 2 diabetes for 30 years, recent research is now building a strong evidence base.

By Dr Matt Capehorn

n just over 20 years, type 2 diabetes mellitus (T2DM) in the UK has more than doubled. Around 3.2 million people now have T2DM, with a new case diagnosed every two minutes. In addition, there are an estimated 1.1 million undiagnosed and 11.9 million at-risk individuals. 85% of these cases are caused by excess weight, and it is in targeting this excess weight that breakthroughs are coming, particularly with the use of formula-based, very-low-calorie diets (VLCDs), which have been used to successfully treat obesity in the UK since the mid-90s.

Reversal and remission The notion that T2DM is progressive and irreversible was challenged in 1999, when the Swedish Obese Subjects (SOS) study reported a significant reduction in T2DM following post-bariatric surgery weight loss. The next game-changer came in 2011, when Lim et al. demonstrated an 800 kcal/day VLCD could put T2DM into remission. After eight weeks on the 800 kcal VLCD, participants’ hepatic and pancreatic triacylglycerol stores had decreased enough to restore beta-cell function and insulin sensitivity. Three months later, most still had normal blood-glucose control.

More recently, early research from a trial using VLCDs to treat obese people with insulin-dependent T2DM has also shown they were better able to lose weight, reduce insulin requirements and manage blood-glucose levels than controls on standard NHS-T2DM treatment. Dr Matt Capehorn GP and Clinical Director, Rotherham Institute for Obesity

There are an estimated 1.1 m undiagnosed cases of diabetes in the UK.

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Type 2 diabetes weight loss Those with T2DM find it twice as hard to lose weight on ‘standard’ weight loss diets – not least because diabetic medications, including insulin therapy, are strongly associated with weight gain. This only goes to further demonstrate the impressive efficacy of VLCDs for

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COLUMN

‘Fat but fit’ is not a reality: the daily strain of obesity By Ailsa Colquhoun

D) is a diet plan that involves eating up to 800 kcal a day, usually replacing conventional th formula-based shakes, soups, bars or meals. PHOTO: © Obesity Action Coalition

weight loss in obesity associated with T2DM. Analysis of weight-loss data by Rolland et al in 2013 from 600 weight-matched obese people, half with T2DM and half without, who completed 12 weeks on a VLCD with concomitant cognitive behavioural therapy and smallgroup support, found weight loss in the T2DM group was more than 90% of that in the non-T2DM group(1). This is a highly clinically significant result. Furthermore, it is consistent with other research citing the benefits of group support and behaviour-change therapy in weight-loss regimen.

A recent review of VLCD use in individuals with T2DM confirmed that such diets were associated with significant weight loss and improvement in cardiovascular risk factors and blood glucose, while being well tolerated. Furthermore, despite the commonly held belief that rapid weight loss on VLCD is associated with rapid weight regain, trials have shown that long term weight-loss maintenance is possible post-VLCD. The increasing evidence around the efficacy of VLCDs for treatment of T2DM with obesity suggests they could play an increasingly important role in stemming the diabesity tide.

ew research from the University of Birmingham showing that there is no such thing as ‘fat but fit’ has resonated with obesity experts on both sides of the Atlantic. Dr Charles Billington, past president and current member of US-based The Obesity Society, says the idea of being healthy and obese is a non-sequitur. He says: “People can see obesity as just a cosmetic problem but this research makes clear that this is not the case. Ultimately, the individual will suffer the health consequences of their excess weight, and the higher your BMI goes the more consequences there are.” The Birmingham study showed that, compared to healthy people of a normal weight, those regarded as healthy and obese had a 49% increased risk of coronary heart disease, a 7% higher risk of stroke, and a 96% increased risk of heart failure. However, for Dr Billington, the most pressing concern for most obese patients is not so much their risk of an earlier death – more how they can deal with the quality-of-life-busting, day-to-day symptoms of their

excess weight. Daily, debilitating pain in their knees, hips and backs, badly swollen lower limbs, breathing difficulties, nasty skin infections caused by skin breakdown and feeling too hot all the time – these are just some of the day-to-day consequences of being overweight. And so undermined is their quality of life, says Dr Billington, that obese people say time and time again they just “want to be free”. The findings from the University of Birmingham study fit well with previous studies published in Obesity, the journal of The Obesity Society. In one such study of 4,340 people with obesity, Dr. D. Navarro–Gonzalez in Spain found that those who had been thought to be healthy had a high concentration of risk factors as well as very high risk for development of diabetes. A similar study of 74,000 Koreans by Dr. Yoosoo Chang found that those who had been thought to have healthy obesity had a very high risk of diabetes.