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Obesity and its Treatment

  dramatic increase in the prevalence of obesity has occurred, for the most part, over the last four decades. Some of the drivers of this relatively recent “pandemic” have been reviewed by members of this Consortium and include shifts in global food system (Swinburn BA, et al., 2011) and changes in energy expenditure in daily life (Hall K.D, et al., 2011) Both of these when overlaid on a genetic “make up” that has been honed over millennia to conserve fat creates a “perfect storm” of weight gain.  The mechanisms underlying weight gain, conservation of fat and resistance to weight loss are deeply engrained in brain pathways that will automatically change both the drive to eat and the amount of energy that we burn in metabolism in order to maintain a predetermined body weight range (Proietto J, 2011). The fight against overweight and obesity with the arsenal of lifestyle interventions including diets and exercise regimes offers only limited success as exemplified in the table below. (Proietto J, 2011).

  

Studies of dietary approaches to long-term weight loss in overweight or obese individuals who were followed for at least 3 years.

 Modified from Proietto J. Why is treating obesity so difficult? Justification for the role of bariatric surgery. Med J Aust 2011; 195 (3): 144-146.

  

In light of the marginal effectiveness of lifestyle interventions in overcoming obesity, pharmacotherapies should be thrust to centre stage. However, recent developments in this area have been far from encouraging. No new pharmaceutical has been approved for the treatment of obesity for at least a decade and recently, long standing stalwart therapies such as sibutramine have been sidelined because of the increased risk of non fatal cardiovascular problems. Unfortunately, this leaves healthcare professionals with very few tools to effectively help overweight and obese patients. 

  

One approach that has proven effective, albeit available to a limited number of patients, is bariatric surgery (see table below for measures of suitability). This is a general term that describes a range gastrointestinal manipulations that, depending on the type of procedure, will offer effective, long term and durable weight loss that can reliably result in at least 50% excess weight loss (see table below for comparison of procedures). 

A number of organizations, affiliated with the Victorian Obesity Consortium, that can assist in weight loss strategies across the board are listed below.

  

Austin Health Weight Control Clinic 
Dr Joseph Proietto esablished one of the first obesity clinics in a Victorian public hospital at the Royal Melbourne Hospital. The clinic has since moved to the Austin Health Repatriation Hospital in Heidelberg and runs as a part of their outpatient program. For further infomation
click here.

Listen to a Podcast about  treatment at the Obesity Clinic  

A growing concern: treatment of obesity at Austin Health - Professor Joseph Proietto

  

Royal Childrens Hospital  - The Centre for Community Child Health (CCCH)

The Centre for Community Child Health (CCCH) has been at the forefront of Australian research into early childhood development and behaviour for over two decades.  

CCCH conducts research into the many conditions and common problems faced by children, such as obesity, language and literacy delay, and behavioural concerns, that are either preventable or can be improved if recognised and managed early. 

A particular focus of CCCH's work is supporting and strengthening community-based professionals and organisations in their work with families to bring about the best outcomes for children. 

Click here for further information or to contact CCCH
  

Dietitians Association of Australia

DAA is the leader in nutrition for better food, better health and wellbeing for all. DAA is the peak body of dietetic and nutrition professionals providing strategic leadership in food and nutrition through empowerment, advocacy, education, accreditation and communication. As the leading nutrition body in Australia, the Dietitians Association of Australia (DAA) has made overweight and obesity a top priority. DAA launched its new obesity strategy and statement in August 2006 stating that previous under-funded and piecemeal approaches had failed. DAA is calling for a new comprehensive, coordinated and evidence-based approach to obesity including recognition of obesity as a chronic disease, dietary management of obesity through Medicare, funding to help struggling families feed their children properly, regulated and more responsible food marketing and a host of other actions.

Go to DAA Website

Search for an Accredited Practicing Dietitian (APD)

Smart Eating for You Resources

Healthy Eating Healthy Weight DAA Statement on Overweight and Obesity

  

Surgical Treatment Options

Primary prevention of a tendency to obesity should be a global priority as should shifts in policy that would underpin this (Gortmaker S.L, et al., 2011). Until these factors start to gain traction, the trend toward obesity is stabilized and there is a shift toward normal weight, we are left with pharmaceutical and surgical options. As noted above, medicinal approaches are limited at the moment leaving the only effective and enduring treatments for the morbidly obese (BMI>40) as bariatric surgery.

  

There are three main forms of bariatric procedures that are performed to different extents world-wide - Roux en Y gastric bypass, Laparoscpic Adjustable Gastric Banding (LAGB) and Sleeve Gastrectomy. Each of these has different effective endpoints, suitability to different patients and risks of morbidity / mortality, (see below)

  

Surgical Treatment options 

  

  Roux-en Y gastric bypass   

  Laparoscopic adjustable  gastric band 

Sleeve gastrectomy 

Modified from Dixon, J. B., N. E. Straznicky, et al. (2011). "Surgical approaches to the treatment of obesity." Nat Rev Gastroenterol Hepatol 8(8): 429-437.
  

  

Summary of the characteristics of current conventional procedures   

 
Modified from Dixon, J. B., N. E. Straznicky, et al. (2011). "Surgical approaches to the treatment of obesity." Nat Rev Gastroenterol Hepatol 8(8): 429-437.

  

 

For further information about bariatric surgery including its suitability for different individuals and availability of surgeons, excellent information can be obtained at
http://new.ossanz.com.au/

 

  

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© 2010 Victorian Obesity Consortium

                                                              

Obesity Info 

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 Healthy Living -
Fighting the Obesity Battle
 

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Where to get help 

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Facts and Figures  

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Research

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