“Obesity in South Africa has reached epidemic proportions and is having a serious impact on the health of the nation. Some 66% of women and 33% of men in this country are overweight and between 10% of men and 28% of women may be classified as morbidly obese.”
So says Professor Tessa van der Merwe, internationally acknowledged obesity expert and the Director of the Centres of Excellence for Metabolic Medicine and Surgery of South Africa, who was commenting ahead of National Obesity Week, 15 - 19 October 2012. With a staggering 2.2 billion overweight people around the world and 500 million obese, the problem is a global one which is growing, according to Prof Van Der Merwe. World experts acknowledge the complicated nature of this disease and there is agreement that it is not just a case of excess calorie intake and diminished energy expenditure.
Prof Van Der Merwe and surgeon Dr Gary Fetter, both of whom practice at the Netcare Waterfall City Hospital in Midrand, were recently honoured with the best presentation award at the 50th SAGES (South African Gastroenterology Society)/SASES (South African Society of Endoscopic Surgeons) Congress for their back-to-back presentations based on the three year outcome data in the field of metabolic surgery. The Netcare Waterfall City Hospital received international accreditation in November 2011 from the International Federation for Surgical Obesity.
Jacques du Plessis, Managing Director of the Netcare Hospital Division, says the award is an acknowledgment of the leading role Prof Van Der Merwe and Dr Fetter, whom recently completed their 830th bariatric surgery procedure and 100th bilio-pancreatic diversion (BPD) procedure as a team, have played in the field of obesity and its treatment. It is also an indication of the high calibre of expertise available at the Centres of Excellence for Metabolic Medicine and Surgery of South Africa, which are situated at selected Netcare hospitals around South Africa.
Du Plessis observes that obesity is one of the most important health issues of our time. “It is a challenge which needs to be tackled with every possibility,” he adds. “Bariatric surgery has been shown to be one of the most effective options available to those obese patients who qualify for the treatment. This therapy should only be sought from facilities where the necessary expertise and facilities are available to ensure success. The Centres of Excellence for Metabolic Medicine and Surgery of South Africa, apply their vast experience and state of the art equipment to ensure outstanding results,” he adds.
Prof Van Der Merwe says that due to the high prevalence of obesity in South Africa, life threatening co-morbidities or associated conditions are common. These include type 2 diabetes, high cholesterol levels, high blood pressure, sleep apnoea, heart disease, stroke, asthma, depression; the list goes on. These conditions are responsible for a staggering 2,5 million deaths per year worldwide. “Morbid obesity is a very serious disease and should be treated as such,” she observes.
Prof Van Der Merwe, a world-renowned endocrinologist, says that while it is true that obesity poses a health risk, overweight people certainly do not deserve to be judged by others. “The truth is that we do not entirely understand why some people are obese while others are not. However, we do know that contributory factors can include hereditary, environmental, cultural, socioeconomic and psychological factors.
While a select few people who are obese can lose the pounds on traditional weight loss programmes, most invariably struggle to keep the weight off over the long term, notes Prof Van Der Merwe. Used on its own, weight management through non-invasive programmes have a high failure rate. Fewer than 5% of patients are successful in maintaining a 5% weight loss by five years.
Prof Van Der Merwe explains that a few different types of metabolic surgery are available, and the right procedure needs to be selected for the right patient to ensure optimal resolution of diseases such as diabetes in the long run. Three to four months down the line from surgery, patients will return to eating a standard small portion of food, four times a day. The volume aspect is therefore not the main modus operandiby which the surgery outcomes are achieved. Rather it is about resetting complex neuro chemical pathways to best possible functioning.
Metabolic surgery is no longer regarded as a highly invasive procedure worldwide, with complication rates of around 4% and mortality rates of less than 0.5% in the internationally accredited centres in the world. This is far less than for most complicated laparoscopic procedures such as colectomies.
Depending on the choice of metabolic surgery performed, 20 year outcome data documents a weight loss of 30-60% of initial weight, which is substantial when compared to the 5% to 10% weight loss achieved on traditional weight-loss diets and exercise programmes. One of the most enticing aspects of the surgery is that people who have the surgery keep the weight off and there is a very high rate of resolution of medical conditions such as diabetes, hyperlipidaemia, blood pressure, fat infiltration of the liver, sleep apnoea and infertility. Metabolic surgery not only addresses several of the co-morbid conditions associated with obesity, but there is also evidence of improved mood, self-esteem, interpersonal effectiveness and quality of life.
According to Prof Van Der Merwe, metabolic surgery should be performed by a team of experienced professionals and accredited surgeons in a clinical setting with adequate support for all aspects of pre and postoperative care. The preparation and follow-up should be managed by a holistic team of specialists, headed by an endocrinologist, whose primary objective is safety, expert clinical governance and the sustainability of treatment.
“There is tremendous expertise and experience available at these facilities and consequently a very high degree of disease resolution and low mortality. In the right hands, metabolic surgery is a proven, viable solution available to morbidly obese patients today, supported to a large degree by medical funders under the right conditions and provided that the patients are on the appropriate medical aid plan,” concludes Prof Van Der Merwe.
For further information please visit the website of the South African Society for Obesity and Metabolism (SASOM) www.sasomonline.co.za.
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