Bariatric surgery is carried out for primarily for health reasons. If you believe you will benefit from bariatric surgery you will need to meet national guidelines for an operation, which have been drawn up by NICE (National Institute for Clinical Excellence) these are:-

• A body mass index (BMI) 35kg/m2 with a weight-related medical condition such as Type 2 diabetes, high blood pressure, high cholesterol, sleep apnoea, or
• A BMI of 40kg/m2 without weight-related illness.

If you want to, you can work out your own BMI by dividing your weight in kilograms by your height in metres squared e.g. (weight) 95kg ÷ (height) 1.5m x 1.5m = BMI 42. An “ideal” body weight would be a BMI of 19-25.

It is important to understand that although bariatric surgery can be successful in reducing your weight and body mass index, it is unlikely that you will reach the “ideal” BMI. However, the intention is to help you to lose 50-70% of the extra weight you are carrying and therefore improve your health and quality of life.

Before being considered for surgery you will need to have been seen in a consultant bariatric surgeon and a bariatric Dietitian who will look at your eating behaviour and any existing medical conditions. They will recommend a personalised programme to help prepare you for surgery. This will need to be followed for at least 6 months and is likely to include dietary advice, medication, blood tests, tests on your heart or lungs and, where appropriate, psychological support.

It is recommended that you join BOSPA (British Obesity Surgery Patients Association – (www.Bospa.org) who can offer support to patients.

The main types of bariatric surgery are:-

• Intragastric balloon
• Laparoscopic gastric band
• Laparoscopic Roux-en-Y gastric bypass
• Sleeve gastrectomy

Gastric balloon

It stays in place for 6 months. On average, patients lose 10-20% of their excess weight with the balloon.

Gastric band

The gastric band is a silicone band which is fitted around the upper part of the stomach to make it into an hourglass shape so that it restricts the amount that can be eaten. The band can be adjusted to make it tighter by filling it with fluid through an access port which sits under the skin below your breastbone. The band is not filled when it is inserted but there is often some post-operative swelling to the stomach which can cause restriction. When this swelling subsides, you will probably feel hungry again and be ready for your first fill at 6-8 weeks post-operatively. You are advised to have 2 weeks off work.  The band results in average of 50-60% excess weight loss over two years.

Gastric bypass

The Roux-en-Y gastric bypass is usually done as a keyhole operation and works by restricting the amount you can eat and also limiting the amount of nutrients and calories which can be absorbed during normal digestion. Patients can lose a significant amount of their excess weight with this operation and many patients with type 2 diabetes find that their diabetes goes into remission or they don’t need to take as much diabetic medication.  On average 70% excess weight loss occurs over 2 years.

Sleeve gastrectomy

The sleeve gastrectomy is a “halfway house” to a gastric bypass. The stomach is divided into one long column and the part which is no longer needed just stays closed off within your abdomen rather than being removed. Restriction of food intake leads to weight loss but the digestive process is not altered as it would be with the bypass. Sleeve gastrectomy is carried out on patients whose body mass index or illnesses mean that the risks outweigh the benefits of the gastric bypass. However, at a later stage the surgeon may agree to convert the sleeve gastrectomy to a full gastric bypass once the patient has lost a significant amount of weight. Weight loss is similar to gastric bypass up to one year after operation.

The bad week for the sports nutrition sector continued this morning as the UK medicines regulator announced it had warned retailers and manufacturers to remove 84 products containing “dangerous ingredients”.

www.nutraingredients.com

Recently joined a relatively new company to the UK myGenomics as a Dietetic adviser enabling the use of my recent Nutrigenomics studies.

What is this science?

The genome is the set of instructions telling your body how to function. It is written in your DNA as a code containing just 4 nucleotides G, A, T and C. There are millions of letters in the DNA sequence spelling 25,000 genes. 99% of the DNA sequence is the same in every person but the 1% variation makes you unique.

Gene variations are known as Single Nucleotide Polymorphisms, or SNPs (Pronounced “snips”). They are created when one nucleotide, or letter, is swapped for another, creating slight changes in the instructions your body follows. Gene variations influence all sorts of things from hair colour to athletic performance and absorption of nutrients. Once you understand your genome you can understand the lifestyle that is optimal for your wellness.

Genetics of Weight Management

The SNPs in the DNA test have been selected from the thousands in the human genome because they are linked to body mass, metabolism and muscle performance. Twin studies show that half the variation in body weight and diet response may be due to genetic factors. The genes were chosen because:

• They have a known role in metabolism
• They are linked to obesity
• Clinical studies show the variation affects response to diets or exercise

Your weight is a combination of nature and nurture. It is influenced by both your genome and lifestyle. Your DNA sequence cannot change but you can change your lifestyle to match your genes.

If you would like to know more go to the company website through this link. nordiskadiet.co.uk

I have completed the low FODMAP course with Kings College London and have the skills and competency to provide this dietary treatment.

What is the low FODMAP diet?

Fermentable, Oligo-, Di-, Mono-saccharides and PolyolS (FODMAPs) are short chain carbohydrates (e.g. fructans, galacto-oligosaccharides, polyols, fructose and lactose) that are poorly absorbed in the small intestine. Ingestion of FODMAPs leads to alterations in fluid content and bacterial fermentation in the colon triggering functional gut symptoms in susceptible individuals. Removing FODMAPs from the diet is effective in improving symptoms of people with functional gut disorders like IBS.

The low FODMAP diet originated in Australia and was developed by a team at Monash University in Melbourne. It has been successfully adapted to the UK by researchers at King’s College London and implemented at Guy’s and St Thomas’ NHS Trust in London.

The diet is effective when FODMAP-trained dietitians provide dietary advice. A recent evaluation has shown that 76% of patients that had seen a FODMAP-trained dietitian reported improvement in symptoms after being on the diet . Well developed and comprehensive written materials were provided to these patients. The diet is individualised to each patient taking into consideration usual dietary intake and symptom profile. Careful implementation is needed to ensure the diet is effective and nutritionally adequate.

A comprehensive course has been set up to train UK-based dietitians on how to deliver and implement the low FODMAP diet for optimal efficacy.

For further information please refer to the Kings College website kcl.ac.uk

I now practice at Chelmsford Medical Centre(CMC) in New London Road, Chelmsford (www.chelmsfordmedical.co.uk)

This is an exciting new development for my company. I am now able to see patients in a modern clinical setting. I will also be planing to work with other healthcare professionals to provide Dietetic & Nutritional treatment where nutrition is linked to other healthcare needs and conditions.

Please go to the CMC website to find full details of my service, fees and to make an appointment please contact  the CMC reception who will be happy to help tel 01245 253760

I placed myself on a low FODMAP diet for a week as part of my course work and its an interesting experience.

I suffered with IBS when at Uni and stress was a major factor. I have been mostly asymptomatic since then, but occasionally get bloating and flatus and the urgency feeling. I know dried apricots are a no no and when I had IBS, onion was a a problem food.

Started the diet a week ago and lasted 6 days!

What was it like? I managed to replace all my high FODMAP foods with suitable alternatives. It requires a lot of pre-planing and needed to buy in enough foods in advance. Needed to shop at several different places to get all the foods required and it does cost more. I planned my meals in advance and planned for when I was eating away from home.

If I fancied something different I had to check the labels before eating. I always had the handbook within easy access.

Its revealing how many foods have a high FODMAP content when you look a the labels.

I did feel more hungry on the diet as I missed my high fibre sources. Eating either rice krispies, porridge and oatbix are not as filling and this did have a physiological effect!

I missed my favourite fruit and veg but tried some more unusual types.

I tended to eat more low FODMAP snacks which had a higher fat/sugar content.

The low FODMAP diet is only for 8 weeks and it improves the symptoms in 76% of IBS sufferers.

Kings  college is publishing another paper this year which was presented to our course on the 18th and looks at actual FODMAP quantities in the diet so keep you posted.

I hope to meet with my IBS case study soon and discuss the next stage of FODMAP reintroduction.

Upto 40% of primary school children’s lunchboxes do not contain any fruit or vegetables, according to the School Food Trust. BBC health highlighted on the 2nd of Oct 2011.

Should we be concerned or do anything?

Continue reading »

Everyone’s done it. You’ve been working out, eating well, fitting better into clothes and feel like you are on top of the world – that is, until you step on the scale, and a number pops up that seems impossible.

Do scales lie? They must, right? Continue reading »