Blog - Auckland Weight Loss Surgery

Jan 22

Ozempic for Weight Loss: Richard Babor on Balancing the Promise and Perils

By AWLS Weight loss drugs

A new weight loss solution named Ozempic is the latest buzz on TikTok, capturing the attention of celebrities such as Jeremy Clarkson and Kim Kardashian. This ‘miracle’ drug, administered through injections in the stomach, thigh, or upper arm, has ignited intrigue and discussions surrounding its effectiveness in weight loss.

Ozempic operates by replicating an appetite-regulating hormone, a mechanism that helps curb hunger and extends the feeling of fullness among its users. While the allure of a potential game-changer in the battle against obesity is undeniable, cautionary notes from obesity experts emphasise that Ozempic is no magic bullet. Users should be wary of potential side effects ranging from nausea and diarrhoea to more serious complications like pancreatitis and gallbladder issues.

Seeking clarity on this groundbreaking drug, Simon Barnett and James Daniels of NewstalkZB radio talked to one of the country’s top bariatric surgeons, Richard Babor, to explore its role within the complex landscape of weight loss.

Here’s a condensed extract from the interview.

Are there just a lot of fat, lazy people out there?

I know from the biology of obesity, and my experience from my patients, is that if it was that simple, we wouldn’t have an obesity epidemic. The people that I see do diets and exercise over and over again. They might move moderate amounts of weight but the hormonal and biological drivers that increase weight are not able to be overcome by combinations of diet and exercise. The science has disproven the notion that all you have to do is cut down what you eat and exercise more and obesity will go away.

Is bariatric surgery the cheats way out?

Most of the patients I see have tried diets and exercise and they haven’t worked. Perhaps they can lose weight for six to nine months and then they put that weight back on. The biological drivers of their obesity are not able to be overcome by just willpower. These people are not stupid, they might be well educated, affluent and well-resourced and are usually highly motivated.

In the 80s, obesity wasn’t a thing. Is it because of the high calorific, high sugar content in food, coupled with a sedentary lifestyle?

Yes, we are a product of our ‘obesogenic environment’.

The solution to population obesity is not bariatric surgery and it’s not Ozempic either. It’s modifying our food ecology. Our food environment is toxic. It’s a very thorny political problem and outside of my area of expertise. There are people in public health working on that problem.

What I can do is offer individuals who are not able to overcome obesity in their own lives, bariatric surgery as powerful tool to bring weight down.

Do you endorse Ozempic and other similar medications?

Ozempic has been shown to reduce weight by 10 or 15%. The problem is there is a world wide shortage because it’s been promoted by celebrities on social media. There are Ozempic clinics popping up in the US.

It does have an effect but it also has strong side effects like nausea, vomiting, diarrhoea, abdominal pain, bloating and some can’t tolerate the treatment.

In New Zealand, unless you have diabetes, it costs $500/month.

Final thoughts

The allure of Ozempic as a weight loss miracle should be balanced against the understanding of its limitations and potential risks. Dr Babor’s expertise emphasises the need to adopt a holistic approach to tackle obesity, recognising that individual solutions, whether pharmaceutical or surgical, must be complemented by broader efforts to reshape our obesogenic environment for lasting change.

Listen to the full interview here:

Sep 26

Love0

Richard Babor on How Weight Loss Surgery Can Prevent Cancer

By AWLS 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?

Sources

How Not To Get Cancer – episode 1

Excerpts from an article by Stuff.co.nz

Mar 11

Love0

Auckland DHB Removes Barriers to Weight Loss Surgery

By AWLS 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