T


he issue of obesity in the UK as we approach 2017 remains contentious. But it’s clear that it’s become one of the most serious


health problems of the 21st century.


How is obesity measured? The most common method of measuring obesity is the Body Mass Index (BMI). BMI is calculated by dividing body weight (kilograms) by height (metres) squared. An adult BMI of between 25 and 29.9 is classified as overweight and a BMI of 30 or over is classified as obese. Half of all adults in north west London are overweight or obese. North west London’s child obesity rates are the highest in England – one in five children aged four to five is overweight or obese. So we know that obesity is a serious problem and one on our own doorstep but what do we actually understand about the issue we’re facing?


“Most people don’t realise that obesity is a disease like cancer or heart disease,” says consultant


surgeon at Charing Cross Hospital, Ahmed Ahmed. “And when you reach the stage of clinical obesity, it becomes almost impossible to lose weight through lifestyle choices alone.”


There is a lot of hard work underway focusing on the causes and identifying potential solutions that go beyond traditional methods of dieting and exercise – primarily, focusing on the hormonal aspects of the problem. “The gut is an important source of hormones that regulate our eating behaviour,” says Dr Tony Goldstone, consultant endocrinologist and senior clinical research fellow at Imperial College London. “There is a lot of promising research underway on how best to manipulate these hormones to reduce our appetite.”


INCREASE IN SURGERY Dr Goldstone highlights the growth in bariatric surgery. “There are several different types of weight loss surgery but the gold standard is gastric bypass surgery,” he explains. “This basically involves re-plumbing the way the stomach and the bowel are connected, missing out the first part of the small intestine as well as creating a smaller stomach. It has profound


effects on appetite and pushes people away from high fat and sugary foods and reduces how the brain responds to these kinds of foods as well.”


70


per cent The


percentage of adults who are expected to be


overweight or obese by 2034


20-30 per cent


The


percentage of total


body weight loss in most bariatric surgeries


It seems to be the change to the body’s hormones that follow the procedure that is the real key to weight loss success. Dr Goldstone cites two studies that back this up; one examining the link between increased gut hormones that signal [to your brain] you are full and reduced food reward after gastric bypass surgery; the other investigating whether patients who have undergone gastric bypass surgery have lower pleasure responses to food than those with gastric banding (a different type of weight loss surgery where the stomach is simply made smaller so the route that food takes is unchanged).


At the Trust we perform over


Image taken from the BBC Three documentary featuring a post mortem on the body of a 17-stone woman


400 bariatric surgeries each year. For many of these patients the surgery isn’t just about losing weight, it will also help ‘cure’ some of the patients’ other existing medical conditions and allow them to lead a ‘normal’ life. Mr Ahmed also believes that weight loss surgery gives obese people a much higher chance of maintaining a healthy weight in the long term.


“This surgery is not designed to make people beautiful, it is not cosmetic. What we are achieving with most of the operations we do is about a 20 to 30 per cent total body weight loss,” he says.


Autumn 2016


Pulse/ 13


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