Surgeon Richard Babor

Richard Babor on How Weight Loss Surgery Can Prevent Cancer

By Before and after surgery, Cancer

Q: What is the second biggest cause of cancer after smoking?

A: Obesity. (No, it’s not alcohol, pollution, radiation, stress, or the sun.)

In his recent documentary series, How Not To Get Cancer, Auckland weight loss surgeon Dr Richard Babor looked at the association between obesity and an increased risk of cancer and his findings are quite disturbing.

“I see how disabling obesity can be and I see a lot of suffering that comes out of cancer. When I first started training as a surgeon, the relationship between obesity and cancer was not understood and now it’s becoming clearer and there is very new evidence that makes that link even more strongly. It’s a real worry for me because I work in both those fields and they seem to be converging.”

Could the obesity epidemic turn into a cancer crisis?

The obesity crisis is getting worse. In 2016 there were almost 2 billion overweight or obese adults in the world.

And because obesity rates are increasing, there is potential for younger generations to have higher rates of cancer than we are experiencing currently. Research shows that overweight or obese children are likely to be overweight or obese adults and we know that being overweight or obese increases the risk of cancer. So the children of today are more likely to have ill health in later life.

Susannah Brown from the World Cancer Research Fund explains further: “What we know at present is that smoking is still the number one risk factor for cancer. But we’ve seen over time smoking rates fall…. and we’ve seen obesity rates increase. We’re getting close to the time where these lines will cross and we’ll see obesity overtake smoking as the number one modifiable risk factor for cancer.”

An opportunity to prevent cancer with weight loss surgery

In obese patients, the whole body is inflamed and inflammation is one of the very important drivers of cancer.

But there is no easy fix to reverse this condition. Once a person reaches the clinical threshold for obesity, a body mass index (BMI) of 30 or more, it’s nearly impossible to lose weight and keep it off through diet and exercise. Anyone who’s been on a diet will know hard it is. Even if you weigh 150kg, after a day on just 500 calories, your body will respond as though you are starving to death! Our body defaults to a weight set point – our physiology conspires to keep us fat.

So how do you lose weight and reverse the corresponding cancer risk once you’re obese? The last resort is weight loss surgery.

Mahlia Ahokava’s story

Mahlia Ahokava, a 36 year old woman from South Auckland who appeared in the first episode of How Not To Get Cancer, is testimony to how weight loss surgery improves life expectancy.

Mahlia had been overweight her whole life. As a child, she was not slim like her siblings. And even with regular exercise, her weight in adulthood yo-yoed between 120kg and 164kg.

Added to the ill effects of obesity, was the discovery that Mahlia had pre-cancerous cells in her womb. Richard Babor explained: “..the cells in the lining of her womb had characteristics, both in their individual appearance and in the pattern they were growing, that suggested these cells were gradually changing from normal cells into cells that are on the first step down the pathway of transforming into cancer cells.”

Major clinical studies show that rates of cancer in females go down by 50% after weight loss surgery. Richard met with Mahlia and explained to her that weight loss surgery would change the hormones that drive her hunger and her ability to eat, leading to weight loss and, hopefully, reverse the progression of the pre-cancerous cells.

Post surgery

Since her surgery in October 2018, Mahlia has now lost 54kg. She’s pleased with the weight loss but, as she explains, it was never solely about losing weight, it was also about improving her health and her fertility.

“When I saw Dr Richard Babor​ he really believed that losing weight would really help get rid of these cells or at least stop the pre-cancerous cells progressing to cancer. I’m also trying to better my fertility. Those were more motivating and important for me than the actual weight loss.”

Her latest womb sample now shows normal cells, a pleasing result for both Mahlia and her surgeon.

“Malia is my first patient having this treatment for the specific reason of cancer prevention and preservation of fertility,” says Dr Richard Babor. “It is an area that still requires more rigorous research and we are hoping to start a project looking into this across a larger number of patients. The hope is that surgery for weight loss in women like Malia will help them not only lose weight, but be able to start a family and in the longer term avoid a hysterectomy and not get cancer.”

Policy changes needed

Although weight loss surgery has the potential to prevent many cancer and chronic disease deaths, Dr Babor warns that it is not the going to save the world.

“Surgeons like me are the ambulance at the bottom of the cliff, surgery can’t solve the world obesity crisis. That will take dedicated government policy change. It’s not too late to fix this crisis for future generations.”

More information

Find out more about preventing cancer through changes in lifestyle, diet, exercise, medicine, technology and our environment, by watching How Not To Get Cancer.

Is weight loss surgery is right for you?

Contact us

Sources

How Not To Get Cancer – episode 1

Excerpts from an article by Stuff.co.nz

Lisa Hardy before and after weight loss surgery

Mental and Physical Transformation for Gastric Sleeve Patient

By Before and after surgery

At her lowest point, Lisa Hardy of The Big Ward reality TV series weighed 129kg and was so severely depressed she was suffering from psychosis. But after a referral from her psychiatrist lead her to bariatric surgery, the 49 year old experienced a transformation. Post-surgery, Lisa benefited from not only the obvious physical transformation that accompanies losing 65kg of body weight, but also a significant mental shift.

Before surgery

Like many people in her situation, Lisa’s depression and weight problems started as a child.

“As a child and teenager, I comfort-ate. I didn’t have a very nice father. He was quite strict and the only thing I could really have pleasure in was eating. I started getting depressed when I hit puberty, probably at 13 or 14, and I didn’t medicate with drugs or alcohol – it was always food.”

The negative cycle of depression and comfort eating carried on right through to her late 40s.

“Before surgery, I was on a six-week cycle of, ‘I’m OK, then I’m down’. And the downs were so bad that I was getting psychosis. I would be hearing voices – that’s how low I got. There was self-harm and things like that. I was on psychosis medication,” she explains.

She was also taking pills for her blood pressure and cholesterol, antidepressants and blood-thinning medication as she was “mini-strokes.”

Psychiatrist referral

Lisa explains how her referral to Dr Richard Babor for gastric sleeve surgery came about as a result of her depression.

“My psychiatrist Dr Jay mentioned that some of his patients who had weight-loss surgery had been cured of their depression. He said that won’t happen with you because yours is chemistry, but it could really help with bringing the symptoms down.”

“He gave me a referral, which led to a team assessing me and saying, yes, I was sick enough and fat enough to go through to Dr Richard Babor’s seminar.”

Lisa and her husband Chris listened to what Dr Babor had to say about a gastric bypass. They also heard that Greenstone Pictures, which makes local reality series The Big Ward, was looking for people who underwent the surgery to feature in series two.

It wasn’t a decision that she took lightly, food had always been her crutch. But the choice to go through with gastric bypass surgery and take part in the TV series was made with three important goals in mind: being to beat her depression, to be able to wear a necklace on her ‘chin-neck’ and to be able to shop at an ordinary clothing store.

After surgery

“Two weeks after the surgery, I was off the blood pressure medication because it was bringing it down too low. Now I’m off everything except my antidepressant!”

Lisa Hardy and Husband before and after surgery

Lisa hasn’t had a symptom of depression since surgery, which is what motivated her to go under the knife in the first place. She was able to return to full-time work which she hadn’t been able to do for years due to her anxiety and depression.

Lisa Hardy before and after surgery

Every week after surgery, except one, Lisa lost weight: “the kilos have just fallen off me.” After losing 65kg since surgery Lisa now takes pleasure in being able to fit regular size clothes.

Lisa Hardy two years after weight loss surgery

“I am two years post gastric sleeve surgery, my highest weight was 129 kgs, my lowest was 64 kgs and i am maintaining at 68 kgs.  My life has been transformed mentally and physically, I owe them a freedom that is not easy to explain.”

Lisa’s new lease on life has inspired her to train and practice as a marriage celebrant, a far cry from the before-surgery days when she unable to work full-time.

“I am back at full time work, two years in July, active and healthy, I will be off all medications in July which is astonishing as pre-surgery I was on a cocktail of anti depressants, blood pressure and cholesterol medication.

“The biggest change to me (other than the physical) is the mental health, I am mentally free of any depressive and anxiety episodes for two years, an absolute dream. I have a new lease on life at 50 years of age, fantastic!”

Surgery not a quick fix

Despite the drastic transformation for Lisa, she warns others considering bariatric surgery, “It’s not a quick fix. Before I had the operation, I could eat everything I wanted and drink everything I liked, and then I couldn’t and it’s permanent. You think, ‘What the hell have I done to myself? I cannot stand up, I’m dizzy, I’m nauseous’ and it’s a roller-coaster of different symptoms. Your whole life changes, so you’ve got to be prepared for that.”

Final word

Here at Auckland Weight Loss Surgery we love hearing these transformational stories. The well-being of our patients is our foremost concern, and that includes both physical and mental well-being.

Lisa Hardy head shot after surgery

We’ll leave you with this final thought from Lisa: “Feeling normal is just wonderful. Feeling normal was my end goal and I’m so normal now, it’s great.”

Sources

Photos kindly supplied by Lisa Hardy.

Extracts from an article by Woman’s Day.

person standing on scales

Auckland DHB Removes Barriers to Weight Loss Surgery

By Publically funded surgery

Obesity is one of the main causes of poor health and premature death in New Zealand. Surgery is an effective treatment for those who are severely or morbidly obese and have been unable to lose weight and maintain the weight loss. Fewer Māori and Pacific people than expected undergo bariatric surgery, and this is something Auckland DHB is setting out to address.

Weight loss procedures either restrict the amount of food people are able to eat, absorb or both. Surgery is not for everyone and it involves a degree of risk and also a commitment to a permanent lifestyle change.

Patient experience drives service change

In 2015 Auckland DHB began a programme of work with Waitemata DHB to develop a standardised approach to bariatric surgery and improve access for Māori and Pacific people. An audit identified that attrition rates were significantly higher for Pacific people than other ethnicities, with more than 70% of Pacific patients referred not completing surgery.

They consulted with Māori and Pacific people who have been engaged with bariatric services, to better understand their experiences and identify areas for improvement.

The consultation feedback and audit results helped drive several service improvements. These include:

  • The acceptance criteria were amended to no longer exclude smokers and the requirement to lose weight prior to surgery was abolished.
  • The assessment process was streamlined with patients seen in a multidisciplinary one-stop-shop and provided with certainty about dates.
  • Psychological support was strengthened, in response to patient feedback.

Results of changes

Early indications from the latest data show that the attrition rates for Pacific and for Māori patients have substantially reduced and are now similar to non-Māori non-Pacific rates. This means that more people are being supported to successful completion of surgery.

In 2017/18 68 people received bariatric surgery at Auckland DH, and of these 37 were Māori or Pacific.

Mike’s success story

After research and a referral from his GP to surgeon Mr Nicholas Evennett, 49 year-old Mike* underwent bariatric surgery at Auckland City Hospital in June 2018. After working hard to lose weight pre-surgery, and attending meetings with a specialist nurse, dietitian and psychologist, Mike qualified for the publicly funded surgery.

Mike says he chose the bariatric surgery path after trying several diet plans and exercise regimes and, in his words, failing miserably.

Life changing surgery

man before and after weightloss surgery“Surgery changed my life. It probably also extended it by up to 20 years. I have significantly reduced my chances of contracting [sic] diabetes, high blood pressure, heart disease and, hopefully, will reduce my need for a CPAP machine when sleeping. I look and feel healthier and I find it much easier to find clothes that fit. I’m also playing sport for longer and with less pain so I’m enjoying it much more.”

Mike says he could not have gone through the whole process without the professional guidance and assistance of the Auckland DHB staff who facilitated his life-change.

“I know I came to the programme with my mind set on achieving results and I was as prepared as I could be, but I couldn’t have done what I’ve done without the care and assistance of the Auckland DHB team, particularly that of bariatric nurse Elaine Yi, who went out of her way to accommodate my work schedule when it came to arranging appointments.”

Post-operative care

At his heaviest Mike weighed 136kg. His surgery weight was 116kg and he currently weighs 94kg. His goal weight is 85- 90kg. Mike has ongoing post-operative care including regular meetings with his dietitian, nurse and surgeon. He’s also part of a pilot programme with the ExerScience Clinic which is examining whether it’s feasible to implement a mandatory exercise component to the overall bariatric programme.

Mike’s advice to anyone in a similar situation is simple.

“Seek advice from your GP, ask them to submit a referral to ascertain your eligibility for publicly funded bariatric surgery. Just do it!”

 

*Name changed for privacy.

This article is an extract from the Auckland DHB Annual Report 2017-18