Question 1

I CAN’T LOSE WEIGHT OR I JUST REGAIN IT WHEN I DO – CAN YOU HELP?

Accepted Answer

Weight loss with or without a procedure requires long-term commitment and lifestyle change to achieve the best results. Although control over the demands of life to make time to plan diet and exercise are fundamentally important, many become frustrated when weight loss stalls or it creeps back on so they give up. 
Scientific evidence now reveals that this complex process is partly because our bodies become very efficient at holding onto weight we have gained when we try out new diets or engage in short bursts of exercise when motivated. 
Losing weight requires a sustained calorie “deficit” (reducing calories in your diet). Although the recommended daily intake for women is less than 2000 calories, weight loss would requires a daily reduction to around 1400 calories or less. 
Weight loss procedures can achieve calorie restriction through feeling fuller more quickly, a reduction in appetite-stimulating hormones and in some cases reduced absorption of energy from food and drink. Options include both temporary endoscopic balloon procedures and more permanent keyhole (laparoscopic) surgery operations.

Question 2

WHO ARE WEIGHT LOSS INTERVENTIONS RECOMMENDED FOR?

Accepted Answer

I would always recommend meeting with your GP to exclude any medical or psychological factors that may have lead to your weight gain before moving on to these options. However I do offer free Mini-Consultations (01482 672414) for those wishing to know a little more before going further. 
Firm evidence that weight loss procedures are effective and safe is endorsed by the National Institute for Health and Care Excellence (NICE). Obesity is when somebody’s Body Mass Index (BMI) reaches 30 or more. Patients with obesity (BMI>30) who have not succeeded in losing weight or maintaining weight loss through diet alone are very likely to benefit from a weight loss procedure. When BMI reaches 35, you are carrying around 50% more weight than is healthy for your height. 
The NHS has an online calculator at:
https://www.nhs.uk/live-well/healthy-weight/bmi-calculator
Examples of where individuals may benefit include when:
Their weight starts to reach a certain threshold that cause medical conditions to develop or deteriorate (diabetes, high blood pressure, arthritis and sleep apnoea) which can be potentially reversed in part or in full by these treatments. 
They are too heavy to have a safe planned elective operation for other conditions 
Where their self esteem, mood or activity levels are impacted upon by their weight
The longer a patient is overweight the more chance there is of developing long-term health problems even if they are yet to be diagnosed. 
When non-surgical measures like diets, exercise programmes or medications have failed to achieve sustained weight loss it as this point operations become very effective tools in helping individuals regain control of their weight.

Question 3

WHICH IS THE BEST PROCEDURE FOR ME?

Accepted Answer

During your consultation, Mr Pellen will discuss the benefits, implications and risks of a range of interventions with you, not just one, particularly because different options are better suited to certain individuals’ circumstances, their goals and their weight loss history. 
Weight loss operations take between 60-90 minutes and are usually performed using keyhole (laparoscopic) surgery under a general anaesthetic. They achieve weight loss through a range of mechanisms such as “restricting” the amount of food you can eat to that which would fit on a small tea plate, reducing calorie absorption and hormone effects that can temporarily reduce appetite. 
You can expect to lose around one-third of your excess weight with a gastric balloon and more than two-thirds of your excess weight with the sleeve gastrectomy and gastric bypass. Most weight loss is achieved within the first year at which point your weight stabilises. 
The gastric band is an inflatable ring placed around the top of the stomach connected to an access port buried under the skin that requires adjustment injections of fluid to achieve the correct sensation of fullness. Mr Pellen does not recommend this procedure owing to significant long-term problems such as weight regain, band slippage and symptoms or complications that require the band to be removed in 1 in 3 patients.

Question 4

HOW WILL AN OPERATION AFFECT ME?

Accepted Answer

These procedures reduce the amount of calories you will absorb leading to gradual weight loss. However they will also reduce other essential parts of your diet including daily vitamins, minerals and protein. Daily vitamin supplements are required life-long to avoid nutrition complications after any operation and for as long as a gastric balloon is in place. A dietitian consultation is always provided before and throughout your weight loss procedure pathway at Spire Hull and East Ridings Hospital. 
Weight loss surgery can lead to substantial reduction in medicines needed for or even reverse conditions such as type 2 diabetes and high blood pressure. Improvements in many other conditions such as sleep apnoea, reflux and joint pain can be seen and weight loss also improves eligibility and safety for many NHS procedures where weight restrictions apply.
Weight loss surgery can have dramatic improvement in fertility. Contraception is an important consideration even if you are planning to start a family as pregnancy is not recommended within the first 18 months to ensure the baby develops healthily.

Question 5

WHAT IS EXCESS WEIGHT LOSS?

Accepted Answer

Excess weight loss is the amount of extra weight you are carrying than would be ideal for your height. The excess weight loss is the average amount of this you can expect to lose for each procedure. More can be lost with increased exercise and activity. Less might be lost if some lifestyle behaviour are not changed such as high intake of sugary drinks, alcohol or snacking.

Question 6

HOW LONG WILL IT TAKE ME TO RECOVER?

Accepted Answer

Both the sleeve gastrectomy and gastric bypass are followed by a swallow test which ensures no narrowing or leaks at the seals and joins are present before a liquid diet is started. Dietitians guide you on what to eat and drink over the next few weeks. Both operations usually require 1 to 2 nights in hospital and patients often recover and return to work within 2 weeks for the sleeve gastrectomy or 2-4 weeks for the gastric bypass.

Question 7

IS PSYCHOLOGICAL SUPPORT AVAILABLE?

Accepted Answer

Many patients who struggle with their weight have a history of emotional or physical trauma and have developed a dependency on food to cope with low mood. An expert psychotherapist Marie Acton with whom Mr Pellen works closely can provide confidential private assessment and support sessions outside of the hospital environment.

Question 8

ARE THERE ANY RISKS OF WEIGHT LOSS SURGERY?

Accepted Answer

The need to convert to an open operation is very uncommon, occurring in less than 1 in 100 procedures under Mr Pellen’s care. 
A return to the operation theatre or other procedures needed for complications occurs in less that 1 in 50 operations. Reasons can include, uncommon but serious complications such as leaks from the joins or seals where the bowel has been stapled or stitched together, or, obstruction (blockage) due to a narrowing from over healing. This may require further treatment with a balloon dilatation (stretch) endoscopy. 
Other risks include bleeding, thrombosis, wound infection and fall in vitamin levels needing replacement. 
Mr Pellen submits data on all of his weight loss interventions to the National Bariatric Surgery Registry.

Question 9

HOW CAN I FIND OUT MORE?

Accepted Answer

To make an appointment to see Mr Michael Pellen, or for further information contact Spire Hull and East Riding Hospital on 01482 672 412