April 2009 Autumn Newsletter

Booth's Babble

April Autumn Newsletter 2009

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Catherine, Nikki and I have just returned from the Obesity Surgical Society of Australia and New Zealand Annual Meeting. This was dove-tailed in with the International Federation for the Surgical Treatment of Obesity; The Asia Pacific Chapter so it was a large meeting and situated in Cairns, Queensland. There were a number of interesting papers presented and there were results presented from large studies of laparoscopic adjustable banding, sleeve gastrectomy and gastric bypass. I am pleased to report that our own results are certainly comparable with the best results that were presented at the Conference and indeed our gastric bypass results of 56kg weight loss at 2 years and 97% excess weight loss were the best figures that we saw at the conference. One particular advantage of going to these conferences is to be able to rub shoulders with other surgeons and learn from their experiences and hopefully come away with new ideas. There were some interesting new procedures that we saw. Single incision surgery where operations are performed between one small incision are now becoming increasingly popular in some parts of the world. My own impression watching these operations being performed is that they are very fiddly, time consuming and patients will spend longer times on the table with little benefit. I may be proven wrong however this is something that we will need to keep a close eye on.

One particular new area of interest is vagal nerve stimulation. The vagal nerves are nerves that run down on either side of the oesophagus into the stomach and then spread out to other abdominal organs including the liver and remainder of the gut. By placing electrodes on the vagal trunks and stimulating them it gives the patient a sense of fullness or satiety. These electrodes are connected to a small pacemaker similar to a cardiac pacemaker which can be implanted under the skin. There were preliminary results but in a different two centres in Australia demonstrating over 20% weight loss as well as reductions in blood pressure. I think this novel therapy is clearly something that we need to keep a close eye on as it may have a role in the future, particularly in patients who may need to lose a lesser amount of weight.

As many of you may be aware we are currently organising a charity ball called The Great Weight Loss Ball. Tickets are beginning to sell and I would be grateful if you could possibly buy your tickets as soon as practicable. We have limited spaces and once all tickets are sold there will be no further opportunities to purchase these. This is all for a good cause and we are sponsoring a charity. All proceeds will go to the North Shore Hospice. It is hopeful that we will run a small charity auction there so please bring your cheque books! There will be a live band playing as well as a pianist and accompanist prior to that. Patients of ours who have had weight loss surgery will be playing in both. If you have any particular talent or skills as far as entertainment is concerned then please contact us and we will see if we can accommodate your talent. Other than that we are looking forward to a great night and look forward to seeing you there. Please do not feel as though you can't come along if you do not have anyone to bring. There will be many patients and people in similar situations and we will endeavour to make sure that people can be put together so that everybody can have a good social evening.

Michael

Multivitamins...

It is still a concern of ours that some of our long term patients are not planning to take Multivitamins. I cannot impress upon you the importance of continuing to take these long term, particularly those patients who have had gastric bypass surgery. The risks of long term neurological damage are small but real and when they occur they are irreversible. I think you really ought to take this into consideration and place your Multivitamins by your toothbrush so that you are getting these at least once a day.

Advice Snippets...

There are a lot of expectations that go with weight loss surgery; the surgery alone with no changes in lifestyle will not give you the results you want. In the early stages it can be easier to comply with the exercise regime, the multivitamins, the food choices, chewing time and follow up appointments but often this enthusiasm diminishes over time.

Everyone that undergoes weight loss surgery comes with expert knowledge; expertise in nutrition, expertise in loosing weight and expertise in weight management. don't forget to tap into that expert knowledge if you need it.

Snacking vs Grazing...

• A snack is food eaten between meals, a light or hurried meal.
• Grazing is daylong feeding, feasting, consumption.
• A snack can be planned, executed and completed with mindfulness to nutrition and caloric need.
• Grazing is constant eating or nibbling without end, resulting in the pouch never feeling satiated.
• A well-chosen snack will boost energy, satiate appetite and fuel the body.
• Grazing is most often void of nutritional, emotional or satiating value. Grazing is mindless.
• A well-chosen snack will not defeat the gastric bypass.
• Grazing will defeat the gastric bypass by allowing too many empty calories to be consumed and absorbed.
• The wise snack list includes items that are high in protein, low in carbohydrates and are rich in calcium, vitamins and minerals to feed the body well. In addition most of these foods will satiate the pouch and it is unlikely one will engage in prolonged snacking on any of these items.
• In other words, make a good choice, enjoy it and move on with your life.
• No more grazing.

I've been on a diet for two weeks and all I've lost is fourteen days

The Great Weight Loss Ball
Spencer on Byron Hotel, Takapuna

"Come celebrate your achievements with us"

31st July 2009
7.00pm-12.00
Dress Formal

Band-Four on the Floor
and Silent Auction

Tickets are $150 ea for
Full Buffet Dinner & Drinks
(Catering for post weight loss surgery patients)

ALL PROFIT WILL GO TO
THE NORTH SHORE HOSPICE

www.nshospice.co.nz/

Special rates available for those wanting to Stay at the Spencer overnight, just ask for The Waitemata Specialist Centre corporate rates when enquiring

www.spencerbyron.co.nz/

The Spencer on Byron Hotel
9-17 Byron Avenue
Takapuna, Auckland
Phone: 09-916-6111

Dietitian's Direction...

I thought you would like to hear the results of some research we have recently conducted here at SWS. I recently looked at and compared pre-operative weight loss with post-operative weight loss in people who had undergone a laparoscopic gastric bypass, to see if there was a connection between the two. My main question was "does pre-operative weight loss influence post-operative success?". I did this for a few of reasons, first and foremost to see if there is a connection, and also as the published research at the moment is controversial regarding this matter. Some studies say that there is no connection between pre-operative weight loss and post-operative weight loss, while others show better outcomes if weight is lost pre-operatively.

Weight loss was determined as a percentage of excess weight loss. This was ascertained by the following calculations:

So essentially I looked at how much weight a person had lost in comparison to how much weight they needed to lose to have a healthy BMI of 25.

People were put into four groups. Group 1. Weight gain pre surgery; Group 2. 0-10% excess weight lost; Group 3. 10-20% excess weight lost; Group 4. > 20% excess weight lost. Weight loss was then looked at the usual times we see people post-operatively (3, 6, 9, 12, 18 and 24 months after surgery).

Our results were good. Our average weight lost pre-operatively was 12% excess weight, with a range of 6% excess weight gained (Group 1) to 26% excess weight lost (Group 4). The average weight loss for the entire group continued to increase as time post surgery lengthened and at two years post-operatively average weight lost was 98% excess weight. This ranged from 87% excess weight lost (Group 1) to 104% (Group 4). The results were statistically significant (meaning that what was done pre surgery was directly influential post surgery) up to nine months post-operatively. After this time, significance was lost due to decreased numbers, not because there was "not a difference any more".

So, in essence, if a person loses more then 20% of their excess weight pre-operatively then they are likely to lose more weight after surgery than someone who gains weight preoperatively. I do not know if this is due to the extra weight loss giving the person a "kick start" prior to their surgery, or if it is indicative of willingness to embrace lifestyle changes which are needed to ensure the success of weight loss surgery long term. This is one of the reasons we encourage weight loss pre-operatively, it has a definite advantage to postoperative success.

As an aside, I thought you would like to know that our average weight loss post surgery tends to be higher than the majority of the published studies out there. Meaning that as a group, you lose more of your excess weight than other people who have had gastric bypass surgery. For this you should be commended and proud of yourselves. The trick is to keep up the new good habits that you have learnt since your surgery and keep the weight off - as if you start to break the rules and go back to old habits, weight regain is not only a possibility, but also a near on certainty.

If anyone would like any more information on this, let me know and I can go into more detail.

Nikki

Support Groups for 2009

These groups have become an important part of a successful outcome with weight loss surgery and it has been great to have been part of the groups over the previous 12 months.

For those of you who haven't joined us yet, they are at their most valuable in the first 12 months after surgery in order to normalise the process and provide support through the frustrations and pitfalls

Things I have learnt from support group are:

• Every plateau in the first 12 months ends with further weight loss
• Hair loss is recoverable and enhanced hair growth (wigs) look great too
• Alpine tea is the best cure for constipation
• Stick to the diet plans and read food labels; supermarket shopping takes longer
• Energy and flexibility are the real gifts of weight loss although clothes and looking at yourself in the mirror are great too
• At times it's hard to remember that you are a thin person and how far that you have come
• Alcohol should be approached with caution
• Good support keeps you going

The dates for 2009 are on the website, however we will stick to the last Wednesday of the month for Takapuna and the first Wednesday of the month for Remuera. Both groups are now open to all those who have had surgery and we are looking forward to seeing you.

Please let us know that you are coming by phoning Sarah or Sandra on 441 2750.

There is no charge for the support groups .

Catherine, Lyn and Nikki

Information Evenings...

Many of you have been along to the information evenings we have been providing for interested people over the last year. We welcome any suggestions as to how these may be improved and do appreciate those of you who have given your time to come along and provide prospective patients with your personal experiences. Start times are 7.30pm, please phone or email for bookings.

Dates for Shea Tce
15 Shea Tce, Takapuna

Wednesday 22nd April 2009
Wednesday 10th June 2009
Wednesday 8th July 2009
Wednesday 19th August 2009
Wednesday 23rd September 2009
Wednesday 21st October 2009
Wednesday 18th November 2009
Wednesday 16th December 2009

Dates for Remuera
81 Remuera Road, Remuera

Thursday 14th May 2009
Thursday 25th June 2009
Thursday 23rd July 2009
Thursday 10th September 2009
Thursday 8th October 2009
Thursday 5th November 2009
Thursday 3rd December 2009

Contact Details...

Phone 09 441 2750, 0508 Weight (934 448) Fax 09 441 2759

Email info@surgicalweightsolutions.co.nz
Website www.surgicalweightsolutions.co.nz

This website is being continuously updated and any comments or suggestions are much appreciated.

We always look forward to seeing you all for follow-up. If you have any comments or suggestions or would like to write a piece for the next newsletter, please let us know.

April Autumn Newsletter 2009

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