Have a read through our answers to some of the most common questions we get asked about obesity, weight loss surgery, and related subjects.
What is obesity?
Obesity is a chronic disease associated with lower life expectancy, a variety of health problems and a reduced quality of life.
No longer just a cosmetic issue brought on by a lack of self-discipline, the World Health Organisation (WHO) recognises that obesity is a chronic progressive disease. It has recently overtaken smoking as the leading cause of preventable death in Australia.
The Body Mass Index (BMI) is a practical way to evaluate the degree of being overweight. It indicates whether your weight is appropriate for your height.
- If your BMI is between 25 and 30, you are overweight
- If your BMI is above 30, you have obesity
- If your BMI is 35, you have severe obesity
What causes obesity?
Research shows that behaviour is not the sole determinant of obesity, which explains why lifestyle changes, including diet and exercise, can be ineffective.
It is commonly accepted that when energy intake exceeds energy expenditure, body fat increases.
This theory, however, does not take into consideration the complex factors underlying excessive weight gain.
With the incidence of obesity rising world wide, despite increased public awareness, it is evident that weight gain is not merely a problem of self-control or a sign of personal weakness.
- Genetics: The metabolic processes underlying weight gain have a strong inherited component. Obesity is a feature of at least 24 genetic disorders and studies in large populations have identified variants in genes that predispose someone to obesity.
- Appetite and Energy Intake: Appetite is very hard to control. The biochemical pathways regulating appetite are powerful. A person’s feedback control system carries complex messages regarding the body’s nutrient state from the gastrointestinal tract to a part of the brain called the hypothalamus, which regulates appetite.It is believed that people with obesity have a defective feedback control system – the appetite-regulation part of the brain does not function properly, and instead, continues to stimulate hunger and food-seeking behaviour, despite adequate energy reserves.
- Calorie Absorption: It has been shown that those prone to obesity absorb more calories from their diet. This is affected by factors such as a person’s gut flora (the micro-organisms found in the gut) and their hormone response to food.
- Energy Expenditure: Activity and exercise account for approximately 20 per cent of the energy a person expends. Around 70 per cent of energy is expended through metabolic processes and another 10 per cent through the processing of food.Energy expenditure varies between people. There is a strong relationship between resting energy expenditure and fat-free mass, which makes weight loss increasingly difficult for people with higher fat reserves.
- Life Events: People can become overweight any time, however there are certain life events that can trigger weight gain. These include pregnancy, menopause, periods of sleep deprivation, giving up smoking, transitioning from an active adolescent to a more sedentary lifestyle, and when beginning or changing medications.There are a number of medications that can cause weight gain including oral hypoglycemics, hormonal therapy, steroids, antidepressants, antihistamines, anti-hypertensives and anti-epileptic medications.
Why is overcoming obesity such a challenge?
Obesity is self-perpetuating. Excess fat reduces energy levels, making it more difficult to exercise. Intense or lengthier exercise causes the body to release the stress hormone cortisol, which not only contributes to hunger, but also promotes fat storage independently of calorie intake.
For men, extra belly fat also raises oestrogen levels and lowers testosterone, making it even harder to gain muscle and lose fat. Reduced muscle mass means a lower base rate of metabolism, increasing the ease of weight gain.
Few people with obesity experience long-term weight loss by lifestyle changes alone. Surgery puts people with obesity back on an even playing field and allows their efforts toward weight management to be effectual and sustainable.
What are the health risks associated with obesity?
Obesity is a medical condition that adversely affects every system in the body. It has recently surpassed tobacco smoking as the leading cause of preventable death in Australia.
At any age, obesity shortens your lifespan. People aged between 25 and 35 who have severe obesity are 12 times more likely to die early than those without obesity. Adults who have obesity at 40 years of age die on average seven years sooner than adults whose BMI is within the healthy range. The impact of years of life lost is greater for men than for women. It has been estimated that the steady rise in life expectancy over the last 200 years may come to an end due to the increasing prevalence of obesity.
The medical problems associated with obesity are referred to as co-morbidities. Eight out of 10 people who suffer from obesity will develop one of the following co-morbidities; six out of 10 will develop at least three:
- Type 2 diabetes
- Heart disease
- High blood cholesterol and abnormal blood lipids
- High blood pressure
- Chronic kidney disease
- Respiratory disease
- Sleep apnoea
- Polycystic ovarian syndrome
- Fatty liver disease and liver failure
- Heartburn and reflux
- Cancer – breast, bowel, liver, kidney, prostate, endometrial
- Blood clots
- Gall stones
- Abdominal hernias
Fortunately, obesity can be treated and weight loss reverses most of the damage.
For example, weight loss surgery resolves type 2 diabetes in 80 per cent of people with obesity once the excess weight is lost.
What are the steps to weight loss surgery?
Step One: Contact Us
The first step of your surgical weight loss journey is to contact us. We will arrange an appointment for you to see our surgeon, Dr Jordaan, and our team of bariatric nurses and allied health professionals.
To ensure you receive the Medicare rebates for your appointment with Dr Jordaan, you will need a referral from your GP or specialist. At your initial consultation, you will have the opportunity to discuss whether weight loss surgery is suitable for you, what your surgical options are and which procedure would best suit your individual needs.
If you would like more information before you book your initial consultation, please come along to one of our patient information seminars
Step Two: Pre-Operative Care
Our aim is to ensure your surgical weight loss journey is safe, smooth and successful.
Should you decide to enter our program, our bariatric nurses will assist you every step of the way including:
- Organising a tentative date and hospital for surgery. This date is usually around four weeks after your initial appointment. Dr Jordaan operates at both Pindara Private Hospital and the Gold Coast Private Hospital so please let the nurse know if you have a preference.
- Coordinating your referrals and appointments with:
- Our dietetic team
- Our clinical psychologist
- Other specialist physicians as required
- Other investigations as required
- The gastroenterologists to arrange a pre-operative gastroscopy
- QML Pathology request form for comprehensive pre-operative blood tests
- Providing prescriptions for pre-operative medication.
Our administrative team is also here to help you navigate through the sometimes confusing processes of the private health system.
Step Three: Preparing For Surgery
There are a number of tasks that need to be completed to ensure you are prepared for surgery and the subsequent weight loss journey.
- Blood Tests: You will need to visit a QML Pathology collection centre for your blood test. The purpose of this test is to see what your base line nutrition and vitamin levels are, so you need to fast (not eat or drink) for the blood test for at least four hours. You do not need to make an appointment – simply turn up at your convenience. We have arranged for your tests to be bulk-billed so you will not have any out-of-pocket expenses for blood tests at QML.
- Specialist Physician Assessment: People with obesity are considered to have a higher risk of operative complications than those of a healthy weight. Dr Jordaan is proactive at rigorously identifying, assessing and managing peri-operative risk factors to ensure your surgery is as safe as possible. This may include an assessment by a specialist physician.
- Nutritional Assessment and Advice: You will have a one-on-one appointment with one of our specialised dietitians to identify factors that may impact on your nutrition before and after surgery. These include dietary beliefs and behaviours, cultural background, psychosocial issues (such as eating motivations) economic factors and goal setting. You will need to undertake a two week ‘induction diet’ to prepare your body for surgery and ensure the safety of your operation. Our dietitians will adjust the pre-operative diet to suit your individual protein and nutrient requirements. After your procedure, our dietitians will develop a personalised eating plan and guide you through each phase of your weight loss journey with written instructions and follow-up appointments to support you through each dietary change.
- Psychological Preparation and Support: The interaction between mind and body is crucial to successful long-term weight loss. Our clinical psychologist, Lorraine Langsford, will assist you to identify barriers and behaviours that have previously held you back from achieving your weight loss goals. She will introduce you to the ‘mindful eating’ program as a tool to overcome the stumbling blocks you may encounter through the weight loss process. For some, continued care with Lorraine will form an invaluable part of their journey.
- Multidisciplinary Team Meeting: Our multidisciplinary team will meet to discuss how we can best support you before surgery, during your recovery and in the months and years afterward to become a healthier, happier you.
- Final Appointment: You may need a final pre-operative consultation with Dr Jordaan to clarify any remaining questions and to finalise arrangements for the day of the operation. Our rooms will also contact you a few days prior to your date of surgery to confirm fasting and admission times.
Step Four: The Day Of Surgery
Today’s the day! You will meet Dr Jordaan again in theatre to start the next step of your journey. It is important not to eat or drink in the six hours prior to your operation. You will be given pain medication and meet your anaesthetist before you go into theatre. Should any specific anaesthetic issues be identified during your pre-operative assessment with Dr Jordaan, an appointment will be arranged for you to meet with your anaesthetist prior to the day of your surgery.
In Hospital Recovery
Dr Jordaan’s advanced laparoscopic surgical skills and our comprehensive pain management program, which includes pain medication prior to, during and post-surgery, means you will experience minimal pain. We will encourage you to be actively walking around 10 to 12 hours after surgery. This is for a number of reasons including minimising the risk of developing deep vein thrombosis and pneumonia.
In hospital, you will be given intravenous fluids for one to two days to maintain hydration. You will undertake a scan the day after surgery to visualise your new anatomy before commencing oral fluids. Typically, people who have a gastric band stay one night in hospital while patients who have a gastric sleeve or bypass stay two to three nights.
Dr Jordaan and his team will visit you once or twice a day to check on your progress while you’re in hospital. Our dietitian will visit you in the days following surgery to explain the recovery phase diet in detail, answer your questions and provide you with written instructions on how to protect your new anatomy. Prior to discharge, you will be given information on wound care and the use of pain medication.
Step Five: Post-Operative Phase
After any weight loss procedure, your stomach will need time to settle to allow the swelling to subside. During this time, it is likely you won’t feel very hungry. Your diet will be based on high protein fluids. You will be provided with detailed information about your post-operative diet, including meal plans and food suggestions for each phase.
In the first two weeks after surgery, you will have a follow-up appointment with our bariatric nurses and one of our dietitians to ensure your recovery is on track.
For all procedures: You will have an appointment with our bariatric nurses one to two weeks after your procedure, to check your wounds and ensure your recovery is well on track. Typically our patients recover well and easily. If the nurse has any concerns about your recovery they will arrange for you to be reviewed by Dr Jordaan.
Dr Jordaan sees all patients 3 months after surgery to review progress and ensure you are on track to reach your long-term weight loss goals.
You will have another appointment with Dr Jordaan twelve months after surgery. After that you will have annual reviews with our bariatric nurses to ensure you sustain your improved weight and health.
For gastric band surgery: In addition to the above, six weeks after the operation, you will have an appointment with Dr Jordaan to check on your progress and to perform the first adjustment. Dr Jordaan will continue to see you every four weeks until your optimal level of restriction has been reached. After you have reached optimal restriction, you should ideally lose between 0.5 to one kilogram per week. You will have follow-up appointments every three months until you reach your goal weight. This usually takes around 18 months – some patients reach their goal weight in 12 months, while others may take up to 24 months.
Once you have reached your goal weight, we would still like to see you once a year for a check-up to ensure your ongoing weight loss success. These visits are important to your long-term health and all efforts should be made to attend.
Before these check-ups you will need to have a blood test to ensure you are maintaining adequate nutrition. Nutritional deficiencies are hard to sense and blood tests are the only reliable way to identify abnormalities.
Of course, if you have any issues or concerns between scheduled visits please don’t hesitate to contact us.