Options for when the diet doesn’t work

“For a person in the early stages of having excess weight, when habits may not be ingrained, dieting can be effective to lose this small amount of excess weight,” said Dr Le Page.
“For a person in the early stages of having excess weight, when habits may not be ingrained, dieting can be effective to lose this small amount of excess weight,” said Dr Le Page.

Almost two in three Australian adults are affected by obesity, according to a report by the Australian Institute of Health and Welfare. But is achieving a healthy weight a matter of energy in versus energy out?

Dr Philip Le Page is an obesity surgeon who performs weight loss surgery and said that even with dedicated support, the majority of obese people struggle with the idealistic view of good health through dieting and exercise alone.

“For a person in the early stages of having excess weight, when habits may not be ingrained, dieting can be effective to lose this small amount of excess weight,” said Dr Le Page.

“Losing weight using commercial or fad diets is often not sustainable in the long term as often people will regain the lost weight, and sometimes even put even more back on.

“While people should always endeavour to improve their diet, it’s very uncommon for people with chronic obesity to achieve long term, sustainable outcomes with dieting.

What is obesity?

The current causes of obesity have been attributed to a variety of factors such as a person’s genetic susceptibility, as well as psychological and environmental factors. More recently it was determined that the body’s ability to store fat can be affected by the bacteria living in the gut and bowel – the microbiome.

“When these factors are combined with lifestyle pressures and other medical conditions, it can mean that a medical approach is needed to weight loss – surgery being the most effective and sustainable,” said Dr Le Page.

Obesity is measured by a person’s Body Mass Index (BMI), with a BMI ≥ 30 falling into the obese category, and BMI ≥ 40 into the morbidly obese category. Patients with a BMI ≥ 40 are considered for surgery even if they have been fortunate to avoid consequent illness, however those with a lower BMI down to 30 often qualify based on a combination of factors.

“These include how long someone has had obesity and has been trying to (unsuccessfully) lose weight through the support their GP, dietitian and/or psychologist.”

Those who are impacted by conditions such as diabetes, sleep apnoea or heart disease are also considered for surgery, as these illnesses can be improved with better metabolism and blood pressure control – which are the primary outcomes of weight loss surgery.

Types of weight loss surgery

Dr Le Page explains the main types of weight loss surgery he performs on Australian patients, which these days are all laparoscopic (keyhole) surgery.

Sleeve Gastrectomy – the stomach is stapled and most of it is removed. Changing it from an inflatable bag to hold your food into a tube i.e. making you fill up very quickly. The hunger hormone ghrelin is also reduced during the surgery – most people report feeling less hungry.

Gastric Bypass – the stomach is stapled to reduce its volume but left inside and the bowel is replumbed. This procedure has profound effects on diabetes due to the effects in the hormones that release insulin and deposit of fat (known as the metabolic effect).

Gastric Band – a ring placed around top part of the stomach, which is inflated using a needle through an external port that sits on the muscles of the abdomen – slows passage of food when someone swallows. It does not involve removal or stapling of the stomach.

Hospital stay is usually two days, recovery from surgery a matter of weeks and outcomes for patients sees rapid weight loss within the first three-to-six months, with the majority of extra weight lost within nine-to-12 months.

“All patients see a dietitian to help with re-learning healthy habits and monitoring nutrition, and assistance is provided through additional team members to see to their health such as psychologist, exercise physiologist, personal trainer, or life coach. These are useful team members to help,” said Dr Le Page.

“It is important for them to see surgeons and other team members experienced in the relevant options for weight loss so they can advise appropriately.

“Despite the dramatic results, surgery should not be viewed as a cure for obesity – it takes ongoing support and upkeep from the patient and their health team.

“Obesity is a chronic illness that needs ongoing clinical support. People struggle with their weight for various reasons – and even when they have support, their own personal habits and the various pressures of life can be a barrier to maintenance,” said Dr Le Page.

For more information visit  HealthShare , a joint venture with Fairfax to improve the health of regional Australians. Or you can find a specialist near you using the health tool below.