As the number of people undergoing weight loss surgery increases, we spoke to consultant bariatric surgeon Simon Dexter about the procedures available and the impact they can have on people's lives.
Nearly two-thirds of adults in England are now classed as overweight, and this worrying trend shows no signs of reversing.
Whilst many will try to shed the pounds with diet and exercise, when this doesn't work an increasing number are turning to surgery.
Weight loss surgery is a last resort for people who are dangerously obese, and requires a lifelong commitment to a change their lifestyle.
In the three years from 2011 to 2013, more than 18,000 weight loss procedures were carried out in the UK and Ireland, of which 76 per cent were funded by the NHS.
Consultant bariatric surgeon Simon Dexter said: "Weight loss surgery is much more accessible and more people who need it are getting it. The proportion of people eligible for surgery continues to increase as the nation gets fatter. At the moment we are not seeing a stalling in the number."
However excessive weight alone does not automatically entitle a person to funded treatment. It is only available on the NHS for people with potentially life-threatening obesity when other treatments, such as exercise and dietary changes, have not worked.
A person's body mass index (BMI) must be 40 or above, or 35 or above if they have another serious health condition that would be improved by weight loss. However the National Institute for Health and Care Excellence (NICE) is considering lowering the threshold for certain people.
For those who meet the criteria, weight loss surgery has been shown to be effective in significantly and quickly reducing body weight and, at the same time, alleviating some related health conditions.
Mr Dexter, who works at Leeds Teaching Hospital and in private practice for Nuffield Health Hospitals, said there were a number of treatment options available and deciding which was most appropriate for a patient was based on a number of factors, including BMI, other health conditions and patient compliance.
At the Nuffield Health Hospitals, procedures include:• abiliti: An implantable sensory device that detects food and activity, monitoring a person's eating patents and exercise. The sensor is placed into the stomach and using a simple wireless connection, the doctor and patient can view the consumption and exercise data.• Gastric banding: This involves reducing the capacity of the stomach using an adjustable band so that the patient feels full after only eating a small amount of food.• Gastric bypass. This remains the most commonly used weight loss procedure, accounting for about 40 per cent of weight loss surgery. It involves the stomach being stapled to form a small pouch, then most of the stomach and part of the intestines are bypassed by attaching a part of the intestine to the small stomach pouch. As a result, the patient cannot eat as much food• Sleeve Gastrectomy. Gaining in popularity, during this procedure the stomach is stapled vertically from top to bottom, leaving a sleeve shaped stomach which is approximately a quarter of its original size• EndoBarrier: The EndoBarrier Gastrointestinal Liner is designed to help patients regain metabolic control of Type 2 diabetes and obesity. The EndoBarrier is placed in the gastrointestinal tract endoscopically (via the mouth) to create a barrier between food and the wall of the intestine and to delay the mixing of digestive enzymes with the food. Physicians believe that preventing food from coming into contact with the intestinal wall and delaying digestion until further down the intestine alters the activation of hormonal signals that originate in the intestine, thus mimicking the effects of a gastric bypass procedure without surgery
In 95 per cent of cases the procedures can be performed using keyhole surgery, with time spent in hospital typically ranging from a day to two nights, depending on the procedure.
When paid for privately, gastric banding can cost anywhere in the region of £5,000 to £8,000 while a gastric bypass will typically cost between £9,500 and £15,000.
Mr Dexter said patients would typically lose between 50 to 75 per cent of their excess weight. Health conditions will also improve in many cases, with some patients coming off medication for conditions such as Type 2 diabetes.
However success will depend on the procedure, and the commitment of each patient to a healthier lifestyle.
Mr Dexter said any surgery was based on the balance of benefit and risk, and was one part of a package of support and care designed to kickstart weight loss and a healthier lifestyle.
He said surgery could have health, social and psychological benefits.
"Most people who are overweight would like to do the things they need to do to lose the weight but are limited by their weight," he said. "With weight loss they are physically, socially and psychologically better and more able to do things."
However he said people's expectations had to be realistic. Although many patients will see a big drop in their weight, not all excessive weight will be lost. Surgery can have an impact on relationships and some deep rooted psychological conditions may remain.
And while the majority of procedures go ahead without complications, as with any surgery there are risks. Some of which are serious and potentially fatal, such as internal bleeding and a blood clot.
However, Mr Dexter said studies had shown the long-term risks of remaining clinically obese, such as heart disease, cancer and strokes, were greater than the risks of having surgery.
For more information on the procedures contact Nuffield Health Hospitals on 0845 154 6495.
