ABSTRACT
Introduction: In Hong Kong, obesity and its associated co-morbidities are increasingly becoming a health and societal burden. Conservative weight management therapy is ineffective in maintaining substantial weight loss in severely obese patients and more invasive interventions are required to achieve sustainable weight loss.
Materials and Methods: Invasive bariatric procedures were introduced to Hong Kong in 2002. Severely obese patients will be seen in a combined obesity clinic where multi-disciplinary assessment was carried out before interventional therapy. Patients will be allocated to various bariatric surgeries such as laparoscopic adjustable gastric banding (LAGB), laparoscopic sleeve gastrectomy (LSG) or laparoscopic gastric bypass (LGB) when operative criteria were met. For selected patients who were not suitable or refused surgical treatment, endoscopic placement of intragastric balloon (IGB) will be used as an alternative weight control option. Multi-disciplinary approach was also applied during perioperative period to accomplish different clinical needs for the individual patient. Results: Over 500 patients were seen in our unit seeking advice on severe obesity. Two hundred and twenty-five patients received interventional therapy which included LAGB (n = 57), LSG (n = 71), LGB (n = 7) and IGB programme (n = 120). Thirty patients (25%) received second bariatric surgery after IGB removal. Adverse events occurred in 20 patients (7.8%) and there was no operative mortality. At 2 years, the mean percentage of excessive weight loss (%EWL) for LAGB, LSG and LGB are 34%, 51% and 61%, respectively. In those patients who received IGB alone, the mean %EWL at removal and 6 months after removal were 44% and 34%, respectively Conclusions: Through a multi-disciplinary weight management programme with different specialties and various bariatric procedures, favourable results can be achieved in patients with severe obesityObesity is one of the most common chronic illnesses in the Western World with a frequency of 10% to 15%. It causes or exacerbates many diseases and is associated with major physical and psychological disability. Data from US national population surveys have shown that the prevalence of being overweight (BMI 25 to 30) and obese (BMI >30) was 61% and 27%, respectively, and data from Hong Kong have shown a lower prevalence of the problem of being overweight (29%) and obese (3.8%). However, the problems of obesity in Hong Kong should not be underestimated especially when the prevalence of obesity in children and adolescents is increasing. Moreover, ethnicity can also affect BMI-related disease risk as Southeast Asian populations have a higher risk of developing diabetes and cardiovascular disease than do Caucasians who have the same BMI values.
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