WEIGHT-MANAGEMENT CLINIC: RAISING ISSUES WITH PATIENTS

Jul 19th, 2011 Posted in Weight Loss | Comments Off
Many health professionals express concern about how a patient will react if the issue of overweight and obesity is raised. They fear that it could damage the doctor-patient relationship. This sensitivity on the part of health professionals reflects the difficulties to be found in discussing obesity not just within a clinic setting but also in society in general.
In the author’s experience the majority of patients understands the reason for raising the subject, do not take offence and are often only too pleased that the doctor or nurse has expressed an interest and understanding of the significance obesity has on their potential disease development.
In raising the issue of obesity it is important that the clinician exercises good communication skills, finds the right language to use in that particular context, avoids the use of medical jargon and puts the effects of obesity in context with the rest of the patient’s medical history. For example, a patient is unlikely to embrace the concept of weight loss as a means of dealing with their type 2 diabetes if the role of medication (which would perhaps be their first expectation) is not discussed and put into context. The clinician needs to address the patient’s concern, discuss how much support is to be offered and to establish an agreed approach towards weight loss.
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SIDE-EFFECTS OF WEIGHT LOSS SURGERY

Jun 18th, 2011 Posted in Weight Loss | Comments Off
The most common side-effects of surgery are secondary to the small size of the stomach remnant in restrictive procedures, and include vomiting and the feelings of bloating and stomach distension. Malabsorptive procedures can lead to iron and vitamin B12 deficiency, and deficiency of other vitamins. Dumping syndrome is a relatively common occurrence. The complications of the obsolete jejunoileal bypass are potentially catastrophic and include acute hepatic failure, cirrhosis, oxalate nephropathy, chronic renal failure and malabsorption syndrome.
In the Danish Obesity Project and Swedish Obese Subjects (NICE 2002) trials, four deaths were directly attributable to surgical complications.
Perioperative problems included subphrenic abscess (7%), pneumonia (4%), wound infection (4-6%), pulmonary complications (3-6%) and hepatic dysfunction (1.5%).
Gallstones are a common long term side-effect.
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EATING DISORDERS: THE MIXED MESSAGES OF OUR MEDIA – THE STRUGGLE TO LIVE UP TO AMERICAN STANDARDS OF BEAUTY

Apr 11th, 2011 Posted in Weight Loss | Comments Off
Ruth Raymond Thone, author of Fat: A Fate Worse Than Death, asserts that if you’re a fat woman in America, you are essentially a second-class citizen: “Studies show that women do not get hired, do not get promoted, do not get grants…. There’s a prejudice against women who do not fit whatever the current description of attractive is. And it does mean sexually attractive. The other thing is people feel free to come up to you and say, ‘Look at that tummy. Don’t you think you better do something about that?’ People say terrible things to large women.”
Thone talks about her own struggle to live up to American standards of beauty and how far she and other women will gO  to meet the cultural ideal of attractiveness. She says that for most of her life she did feel attractive, but only because she managed to stay thin by chronically dieting. Dieting, it seemed, was automatically part of a woman’s life. “What I have done and what women do is very, very destructive to health, and, in fact, sometimes results in death, as you will find with anorexia and bulimia.”
Thone recalls the time a doctor told her that she needed to quit smoking. “I stopped for two weeks and started to gain weight. So I immediately went back to smoking. That is blatantly a choice to die of either lung cancer or emphysema rather than be heavy. That’s a really stupid choice. But it’s a clear choice that millions of women make every day. Stomach stapling, jaw wiring, surgery that’s conducted on faces and bodies—there’s a lot of life-threatening stuff that goes on in the name of what you look like. So it’s a life-and-death issue for women. It’s a huge issue that I don’t believe will be over in my lifetime. In fact, I think it’s getting worse.”
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DRUGS ANG TREATMENT FOR FAT LOSS: TECHNIQUES AT SURGICALLY REMOVING FAT

May 8th, 2009 Posted in Weight Loss | no comment »

These are known best as the ‘plastic surgery’ techniques. They involve removing fat by (a) cutting it off (called ‘lipectomy’ or Ob) ‘sucking’ it out (called ‘liposuction’). These techniques have typically been used on females, but up to 25 per cent of patients are now male, particularly looking for abdominal fat reductions.

Lipectomy. Fat is removed from under the skin through a surgical incision, and the skin pulled tighter over the area. The process is used on the thighs, arms, abdomen and breasts and up to 5kg of fat can be removed at a time. There is a concern though that fat may return to other parts of the body and that post-operative care must be paid to diet and exercise.

Liposuction. Liposuction involves ‘sucking’ fat cells from a small incision with a vacuum-like apparatus. Only small amounts can be taken at a time (e.g. up to 1kg) and for this reason it is used as a ‘body sculpting’ procedure rather than a significant fat loss operation. Liposuction causes bruising and can leave an uneven result in the hands of less skilled surgeons, although scarring from cutting is less.

There have been a number of other surgical techniques used to deal with obesity over the years, many in an experimental attempt to find an appropriate procedure. By 1993 there were 43 different operational procedures or modifications used in such a way. Recently, criteria have been established for accepting such procedures, and these have resulted in a number now being regarded as of questionable value including the following:

. . . tooth wiring, acupuncture, hypothalamic centre manipulation, liposuction, balloon insertion, unhanded gastric partitioning, vagotomy, gastrogastrostomy, horizontal gastroplasty, gastric wrap, gastrodip and any variety of gastroplasty without a reinforced stoma, intestinal bypass, duodenal bypass and biliointestinal bypass.

Surgical treatment of obesity is therefore limited, but some procedures may be of use in intractable cases of obesity in combination with other standard fat loss procedures.

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