Anti-obesity drug sibutramine (Reductil) has had its licence suspended and GPs are being asked not to issue any new prescriptions for the drug. The suspension follows a review of the drug’s safety by the European Medicines Agency (EMEA) on the basis of data from the Sibutramine Cardiovascular Outcomes study.
This follows the suspension of the marketing authorisation for Accomplia (Rimonabant) in October 2008. The EMEA decided that the benefits of Acomplia, no longer outweighed its risks.

This leaves Orilstat (Xenical) which acts by reducing the body’s ability to absorb fats as the only major drug left in the GP’s armoury when attempting to manage obesity through conservative (non-surgical) means, although many patients find some of the side-effects of this drug unpleasant and/or embarrassing.

The review which brought about the suspension of Reductil concluded there was an increased risk of non-fatal heart attacks and strokes with sibutramine. The EMEA said that this risk outweighed the benefits of weight loss, which was modest and may not have been sustained in the long term after stopping treatment.
Prescribers are being advised by the MHRA not to issue any new prescriptions for sibutramine and to review the treatment of patients taking the drug. Pharmacists are asked to cease dispensing the medicine.
People who are currently taking sibutramine are advised to make a routine appointment with their doctor to discuss alternative measures to lose weight

Last year, 86,000 people were prescribed sibutramine on the NHS. The drug was licensed for as adjunctive therapy within a weight management programme. Its indication was limited to patients with either nutritional obesity and a BMI of at least 30 or nutritional excess weight and a BMI of at least 27 in those with obesity-related risk factors.

Surgical intervention for weight loss is, or should be, only considered for patients with a BMI of at least 40, or a BMI of at least 35 if they have other weight-related severe medical problems. For patients whose obesity is still a significant problem, but who do not qualify for surgery, the Intragastric Balloon is a procedure worth considering. It is designed to remain in the body for 6 months and enable the patient to lose (on average) between 10 and 30 KG, though careful management and long term dietary change must be part of the programme.
For further information on the Balloon and on Surgical solutions to Morbid Obesity please visit http://www.cosmeticbliss.co.uk/p/weight-loss-surgery

Sport & Health News.com, 21st January 2010

Access to NHS weight-loss operations is inconsistent, unethical and a postcode lottery, says Royal College of Surgeons
Obese patients are being “effectively encouraged� to pile on the pounds to qualify for weight-loss operations on the NHS, the Royal College of Surgeons warns today.

The college claims lives are being put at risk as some health trusts require patients to reach higher body mass index (BMI) levels than others before they receive surgical treatments.

The postcode lottery means that access to NHS weight-loss surgery is “inconsistent, unethical and completely dependent on geographical location�, according to the college.

Last year 4,300 operations to reduce body weight were carried out on the NHS, but as many as a million people could meet the National Institute for Health and Clinical Excellence (Nice) criteria for being classed as having severe obesity.

Bariatric, or weight-loss, surgery is carried out after diets, drugs and lifestyle-altering interventions are seen to have failed. It is not generally recommended for children or young people.

“Constraints on NHS funding mean that in some areas NHS decision-makers are opting to ignore professional guidelines and are denying patients’ access to surgery,� the college maintains. “In others, patients who already meet the [Nice] criteria are forced to wait until either they become more obese or develop life-threatening illness like diabetes or stroke.�

According to the Nice guidelines, bariatric surgery is recommended for adults with a BMI of more than 40, who have other significant diseases (for example, type 2 diabetes) that could be improved if they lost weight, and who have tried but failed to lose weight using non-surgical techniques.

The college, which is holding a conference on the issue today, says that hospitals are assessing patients referred from primary care trusts under different eligibility criteria, resulting in some patients with a BMI of 60 or greater being refused surgery while others with a BMI of 40 or less are undergoing operations.

“Nice guidelines are meant to signal the end of postcode lotteries yet local commissioning groups are choosing not to deliver on obesity surgery,� said the college’s director of education, Prof Mike Larvin. “In many regions the threshold criteria are being raised to save money in the short term, meaning patients are being denied life-saving and cost-effective treatments, and are effectively encouraged to eat more in order to gain a more risky operation further down the line.�

Another bariatric surgeon, Peter ­Sedman, said: “There is absolutely no doubt that some patients more needy of surgical treatment than others are being denied it. I will treat the patient, my hospital will offer the service, but unless the patient moves house they will not be referred and if they are the treatment is subsequently blocked.�

David Haslam, chair of the National Obesity Forum, added: “Bariatric surgery is amongst the most clinically effective and cost effective specialities in any field of medicine, preventing premature death and transforming lives, whilst saving vast amounts of money for the NHS and the economy.

“Even the most cynical taxpayer should support bariatric surgery, alongside clinicians, in opposing the unethical and immoral barriers to surgery imposed by NHS purse-string holders.�

The college is calling on the Department of Health to ensure all patients have equal access to treatment. It estimates that obesity problems cost the NHS £7.2bn a year.

Alberic Fiennes, president-elect of the British Obesity and Metabolic Surgery Society, said: “We recognise the difficulties faced in dealing with a ‘new’ disease of epidemic proportions, but to limit surgery to the most severely obese is unfair and short-sighted and against basic professional ethics. It is also contrary to strategies that are standard for diseases that overwhelm resources.�

Michael Dermody of Cosmetic Bliss – specialist provider of Weight Loss Surgery examines the reasons why some patients who undergo surgery are unable to maintain weight loss after the procedure, and offers some possible solutions.

After all else has failed over years – all the various diets, fitness and exercise plans, all the various weight loss regimes and appetite suppressing or “fat bustingâ€� drugs, Bariatric Surgery is seen the last chance to lose weight permanently by those suffering from Morbid Obesity. Rightly so! It isn’t a soft option or a quick fix, and many patients only reach the conclusion that surgery is the sole option left to them after months – often years – of pondering on it.

So why is it that even after surgery some patients still can’t seem to lose significant weight or can’t maintain the weight loss they achieved in the first months after the operation?

Bariatric Surgery is performed in order to restrict the amount of food which can be eaten at any one time, as in the case of such surgical procedures as Gastric banding (the Lap-Band) or Sleeve Gastrectomy (the “Gastric Sleeve�) or in order to both restrict intake and also to limit the body’s ability to absorb nutrients from the food which is eaten, by surgically shortening the small intestine (a technique called “malabsorption�) which is the purpose of the various different types of Gastric Bypass procedures surgeons carry out.

If you read through some of the Weight Loss Surgery forums – as I do – or if you have worked in the field of Obesity Surgery for any length of time – as I have – you can’t fail to come across patients who have had surgery, even the most drastic and complex forms of Gastric Bypass, and still can’t sustain weight loss. Why is this? You will hear lots of reasons put forward by the patients themselves, but far more often than not these are attempts to “blameâ€� the failure on outside reasons rather than looking within themselves and examining their own behaviour. “My band failedâ€� My band slippedâ€� The surgeon didn’t remove as much stomach/intestine as he should have.â€�

It is probably easier to first try to answer the “how?� question than the “why?� question.

What happens, in simple terms is this: either the patient after surgery eats too often, constantly grazing on food throughout the day, or eats a lot of food which is too high in calories (chocolate, high fat food, sugary drinks, alcohol) or does not attempt to increase energy output through reasonable exercise or a combination of these things.

The “why?� question is a bit more complex.

At Cosmetic Bliss we specialise in preparing patients for Weight Loss Surgery, accompanying them and taking them through their visit for the operation with our support at our partner hospital in Breclav in the Czech Republic, where the surgery is carried out by Dr Michal Cierny Ph.D, a leading Bariatric surgeon and specialist in the performance of Sleeve Gastrectomy. A multi-disciplinary team, which includes a psychologist with a considerable experience of exploring issues concerning obesity work with Dr Cierny to ensure surgery can be safely carried out and that the patient is likely to be capable of succeeding in long term sustained weight loss following the operation. We also commit ourselves to supporting and advising our patients in the months and years after surgery.

When preparing patients for surgery, even at the “initial information� stage, we put a great deal of emphasis on the requirement for a patient to be fully prepared for surgery. Surgery will bring many changes, and patients need to be aware of this, and have some coping strategies in place to help them adjust their relationship with eating. We stress the fact that success is only 25% down to the operation and 75% down to the patient themselves, and their determination to make it work. We tell all patients SURGERY NOT A MAGIC WAND! – weight loss after surgery requires effort and commitment, and it is certainly not “the easy way out� as some of the media suggest ( and some advertising by surgery providers implies!).

No one gets to the point of morbid obesity unless they have real psychological issues which involve eating: it is self-deluding to pretend otherwise, and whatever “skeletons in the closetâ€� which may have caused an imbalance in the patient’s relationship with food will still be there after surgery. If comfort eating as a refuge from the bad things which have happened in life caused the obesity, what will happen after surgery, when the patient can’t eat in such volume? If failure to stick to healthy eating regimes before surgery was because of the patient’s view that failure – for them – is inevitable, how can we help them make changes in the way they look at life to allow them to break this vicious circle?

All too often, it seems to me, patients are not sufficiently encouraged to examine the reasons for their weight problems, and they decide on surgery with insufficient information (quite apart from a lack of information on the technical aspescts of what they are planning to do, but that is another story), insufficient self-examination and preparation, and unrealistic expectations of what surgery will do for them. The result is that they are “programmed for failure�. Overeating after a surgery which drastically restricts the stomach’s capacity can be very painful and unpleasant, and it is a measure of some post-operative patients’ inability to make the required changes, one could say almost a determination to defeat the purpose of their surgery that they are willing to put themselves through this discomfort and a real risk to their health.

The aim of Bariatric surgery is to achieve long-term sustained weight loss. it is a terrible disappointment for the patient in terms of their health, the investment they have made in time, money and the discomfort of going through an operation, and also in regard to their self-esteem and sense of achievement if they fail. It is the duty of those who advise and facilitate surgery to do all they can to ensure this does not happen.
Cosmetic Bliss patients have a very high success rate for long term weight loss following surgery. A patient’s success is not inevitable, nor is it guaranteed, but the seeds of success start with our being absolutely frank and honest about what surgery is, what it can and can’t do and what the patient must do to make it successful.
By working with our patients in this way, we can help them to be properly prepared for their surgery, and come to it with their eyes open.
This provides a very good start for a long, but ultimately very rewarding journey.

All information on Cosmetic Bliss Weight Loss Surgery Solutions can be found at http://www.cosmeticbliss.co.uk/p/weight-loss-surgery

Many healthcare companies are in the market offering to organise and assist patients who have decided to “go private� for their procedures – either as a first choice or because surgery is simply not available to them under the national health scheme.
Most prospective patients, certainly in the UK and Republic of Ireland, arrange their private treatment through commercial providers and/or facilitators, rather than attempting to deal direct with the surgeon, and many providers offer a range of procedures, from Cosmetic Surgery, Dental Treatment or Laser Eye Surgery to Obesity Surgery and General Surgery.
It can be quite bewildering for the prospective patient who must not only attempt to learn as much as possible about the procedure they wish to undergo, but also try to select a surgeon and medical team they are willing to put their trust in, and to choose a company which will inform and guide them honestly and put the patient’s best interests above their own desire to “make a sale�.
Michael Dermody and Deborah Darling of Cosmetic Bliss – a private healthcare company which arranges weight loss surgery and post-weight loss cosmetic surgery in the Czech Republic for English-speaking patients are calling for better standards of clear communication and improved support by healthcare facilitators for their patients – especially in the field of weight loss surgery , their own specialist area.
Michael Dermody is quoted as saying
“Our company’s high reputation on the various weight loss forums is founded on our being able to provide thorough and extensive information to our patients pre-operatively, ensuring that they are properly prepared for their surgery; supporting them whilst they make the visit for the surgical procedure and being available to them during the period of weight loss after their surgery.
I think what makes us special is the “hand-holding� service we give whilst the patient is with us for surgery. We make sure we are there – in the hospital – with them throughout their stay, and this is something our patients really value above everything else. Of course we couldn’t do it without the co-operation we get from our partner hospital and surgeon.
We realised a long time ago that taking patients through weight loss surgery was very different from arranging Cosmetic Surgery – it is much more demanding, and requires a much greater commitment by the provider
Firstly, there is the matter of assessing the patient’s suitability for surgery. Quite apart from fairly rigorous pre-operative preparation and testing, some of which should be done well before the surgery itself, there is the issue of making sure the patient is really ready for surgery and prepared to make the mental adjustments, in terms of relationship to food which are necessary if the surgery is to achieve long-term weight loss. Then there is the question of putting in place for the patient an adequate system of support and monitoring during the months and years after the surgery. Unless all these things are done, and done correctly, there’s every chance a patient is wasting their money in having the surgery, as the whole point of the exercise is for the patient to achieve sustained, long term weight loss, not merely a good safe operation with clean scars!
It disheartens and worries me when I see that there are still some companies out there that sell weight loss surgery in a way I would expect to see furniture sold, with “special offer� discounts, and “last minute deals�. It all seems to diminish the serious nature of the surgery and the commitment the patient has to make. More alarming, though, is the lack of quality information provided by some companies – and in some cases positively inaccurate and misleading information is openly advertised on websites. There are still providers of weight loss procedures who advertise a Gastric Bands as being “the same as Gastric Bypass�, and even one promoting Intragastric balloons (a non-surgical temporary endoscopic procedure) as “Lap Bands� .
That’s no different from selling someone a cat, and telling them it’s a dog, on the grounds that “it’s the same thing�!
I know that many companies do a good job, but it is not fair or right to expect the enquiring prospective patient to be able to distinguish between accurate and misleading or inadequate information – especially as they often come to the marketplace having done very little research before contacting providers.
I firmly believe that there is a crying need for Private Healthcare providers and Medical Tourism companies to get together – probably in the form of a trade organisation – to set agreed standards of care, support and accuracy of information, and devise a form of accreditation – not only for the sake of their own reputations but in the interests of true patient care.
Our own facilities in Breclav Hospital are specifically geared to Obesity Surgery, and there are emergency and ICU departments on hand at this modern major hospital to enable us to safely cater for those morbidly obese patients who have other serious health problems. We are working closely with the hospital and Dr Michal Cierny PhD, the Specialist Bariatric Surgeon in charge of the Bariatric and Metabolic Centre there in creating a European Centre of Excellence in Bariatric Surgery.
We are currently actively seeking to co-operate with other providers and facilitators of Private Healthcare – especially in the UK, Eire, and North America – who have a close and trusting relationship with their patients and who share our own commitment to the quality of information and pre- and post-operative care standards for Bariatric patients I have described.
We are willing to develop working relationships with companies who wish to take full advantage of our facilities for safe surgery, and who will value the round the clock support we will be able to provide to their patients when they are with us for surgery. This will enable the provider to focus on putting in place a solid system of pre-and post operative support, and we would welcome enquiries from other Private Healthcare companies working in this field who are interested in developing such a relationship, and promoting standards of excellence in the area of Obesity Surgery and care and support in managing weight loss post-surgery.
We would welcome enquiries from Healthcare Providers and Facilitators, initial contact can be made with us through our website: http://www.cosmeticbliss.co.uk/p/contact

Despite the yearly rise in the numbers classified as “Morbidly Obese” in the UK, and the drain on public health resources due to the costs of treating chronic illnesses which are caused by this epidemic of obesity, the provision of Surgery as an option for patients is still very scant in most areas of the UK. An article in the Scotsman on 27/12/2009 stated that only 0.8% of Scots eligible and willing to go ahead with Obesity Surgery receive it. In England the situation is marginally better – 1.2%!!
When NICE (The National Institute for Clinical Excellence) issued Guideline 43 in December 2006, it clearly stated who should be considered for surgery – patients with a BMI of over 40 (or over 35 with obesity-related “co-morbidities�) who have exhausted attempts to maintain weight loss through more conventional methods. The guidelines also recommend Surgery as a “first line option� for patients with a BMI of over 50.
In Jan 2008 BOSPA (the British Obesity Surgery Patients’ Association) published a survey of the attitude of PCTs – those bodies in the UK who are responsible for allocating funding for surgery. Many did not respond, but of those who did around half confirmed they applied much stricter criteria when approving funding of surgery than the NICE guidelines. There remains no clinical justification whatever for denying surgery to patients who meet the NICE guidelines – so the practice of insisting on much more severe criteria before allowing surgery is clearly based on limiting cost. Local PCTs clearly have a finite budget with many competing demands, and Obesity surgery is potentially a great drain on their resources. The NICE guidelines are, after all, only guidelines and are not legally enforceable – though some patients have sought legal redress for the failure of their PCTs to adequately deal with their health problem.
It seems a very short-sighted approach, in terms of the PCTs duty to provide adequate healthcare, condemning obese patients to become more ill as the obesity-related diseases develop, and even from the cost point of view studies have shown that Obesity Surgery pays for itself over approx. 3 years, as the cost burden of treating co-morbidities such as Type II Diabetes is reduced in patients who have lost significant weight. The government makes little provision for tackling this epidemic, and largely leaves PCTs to “get on with it as best they can�
So, what can someone who is classified as Morbidly Obese, and needs surgery do?
It is possible to attempt to put pressure on your local PCT through your GP to approve surgery, but it is a long uphill battle, with very little prospect of success.
You can look for surgery privately, which is the course most obese patients follow.
There are problems and pitfalls here, quite apart from the cost you will have to meet.
Firstly you have to be careful to choose a surgeon, hospital/clinic and company, (if you arrange your surgery through a Healthcare company as most do) who are not only experienced in the type of surgery which will be best for you, but also you must be sure that all the pre-operative health checks and tests are at least as extensive as in the NHS. It goes without saying that every effort should be made to ensure your surgery is as safe as possible. Psychological evaluation and some counselling to ensure a patient is at the right point to be able to succeed with weight loss following surgery is absolutely vital. NICE recommends that obesity should be managed by a multi-disciplinary team, and that post-operative support is essential
Post-operative support – whatever the surgery – is very important and you should be careful to chose a surgery provider who is willing to offer this, and not simply prepared to leave it to your GP to give advice and help after the surgery.
Cosmetic Bliss http://www.cosmeticbliss.co.uk/p/weight-loss-surgery is a weight loss surgery company who arrange safe Obesity Surgery for English-speaking patients at the Bariatric and Metabolic Centre – Breclav Hospital in the Czech Republic with Dr Michal Cierny PhD the Bariatric surgeon. They have a great deal of experience in preparing patients and giving them sufficient information to ensure safe surgery. The hospital is working to become a European Centre of Excellence in Bariatric Surgery, and the pre-operative health checks and tests for patients are very extensive. Cosmetic Bliss accompany all patients throughout their stay at the hospital and provide a full system of post operative support, nutrition diet and exercise advice. They encourage regular post-operative contact and follow up with patients for a minimum of 2 years after surgery, and monitor post-operative outcomes and weight loss following surgery on behalf of Dr Cierny. They are keen to work with UK GPs in providing post operative support to all patients. Although initially many patients are a little intimidated by the prospect of having surgery abroad, the quality of care, the system of safeguards Cosmetic Bliss and the Hospital have put in place, and the hand-holding service Cosmetic Bliss provide whilst the patient is in Hospital make it a very reassuring experience. Prices are fully inclusive and the cost is significantly lower than arranging for surgery in the UK also.

27 December 2009 – By Lyndsay Moss, The Scotsman
THOUSANDS of Scots are missing out on surgery that could transform their lives because not enough priority is being given to the treatment of obesity. Type 2 diabetes, which can lead to serious health complications, is one of the country’s fastest-growing conditions, largely because of poor diet and a lack of exercise.
But procedures such as gastric band and gastric bypass surgery that are proven to work are being denied to patients because health boards are not willing to finance them. Duff Bruce, an Aberdeen surgeon and chairman of the independent Severe and Complex Obesity Treatment Service (Scots), said that up to 25,000 Scots could be eligible and would be willing to have such surgery to improve their health.
If more patients were offered surgery, their health could be improved and the NHS would save money in the long term. But despite the growing problem, Scotland has one of the lowest rates of bariatric surgery in the world. In Scotland only 0.8 per cent of those eligible and willing to have weight-loss surgery receive treatment, compared with 1.2 per cent in England, 5.5 per cent in Sweden and 9 per cent in the United States.
Writing in the magazine of the Royal College of Surgeons of Edinburgh – published today – Bruce said patients with severe obesity, with complications such as diabetes and high blood pressure, are “one of Scotland’s fastest-growing and most difficult to manage populations”, taking up a disproportionately large share of the £171 million cost of treating weight-related problems.
But research has shown that obesity surgery can have a major effect on improving the health of obese patients.”With the data available to show that patients with Type 2 diabetes often go into remission following a (gastric) bypass, we are, as a nation, essentially withholding an intervention that could potentially cure not just sufferer’s obesity, but also much of their metabolic co-morbidities (conditions such as diabetes],” Bruce wrote.
He said: “There’s a significant percentage of patients who we know would be eligible and willing to have the operation who haven’t got access to the resource.”
Writing in the same issue, Dr Ingmar Naslund said Sweden has prioritised obesity surgery over other groups of surgery, such as gall bladder and hernia operations, and has reaped the benefits. “As we’ve helped more and more patients with obesity, it has become more obvious that these patients are the right ones to be prioritising,” he said. One in four men and women were classed as obese in 2008, and patients who are overweight are more likely to develop Type 2 diabetes. Severe obesity can also cause high blood pressure, heart disease, bone and joint problems, and sleep apnoea.

Almost 200,000 people north of the Border are estimated to have Type 2 diabetes, which is normally diagnosed in people over the age of 40.The number of bariatric procedures carried out in Scotland on the NHS each year is between 150 and 180, with a similar number carried out privately. A gastric band is an inflatable silicone device surgically placed around the top portion of the stomach. The device creates a small pouch at the top of the stomach that quickly fills with food, sending a message to the brain that the whole stomach is full. This sensation helps the person to be hungry less often, to feel sated for a longer period, to eat smaller portions and thus to lose weight. Gastric bypass surgery works in a similar way by also reducing the stomach’s volume.

One problem is the cost of the procedures compared with other surgical treatments. Obesity surgery and follow-up care costs the NHS between £3,500 and £5,500 per patient, so access to such operations in Scotland has so far been limited.
But Bruce said prioritising obesity surgery would save the NHS money over time, as it would spend less in the long term on weight-related conditions such as heart disease.
Research in Canada has suggested that bariatric surgery was “cost neutral” within three years because of the savings made on treating other complications.
Bruce said he hopes that with better and more clever use of resources, more patients could be given access to obesity surgery. He said: “In Scotland, we are starting from quite a low baseline. But Scotland is a small country, which means that everyone can work together well. We have good relationships with clinicians, health boards and government.”So hopefully, we have a chance of developing a national strategy that works well to deliver and develop this.”
A Scottish Government spokeswoman confirmed that obesity was one of the greatest health challenges facing Scotland. “That is why the Scottish Government is investing £56 million in our Healthy Eating, Active Living action plan which aims to improve diet, increase physical activity and tackle obesity,” she said. But she added it was a matter for individual health boards to decide what services to provide and how they allocated resources to meet needs.
• A £450,000 funding boost for the treatment of diabetes was announced yesterday by public health minister Shona Robison. The money will be invested in improving psychological support for people with the condition.
Case study
VICKI Simpson had to wait four years for surgery to treat her weight problems.
The 39-year-old from Aberdeen had a gastric band fitted in January 2007 and later a gastric bypass.
“It is the best thing I have ever done,” she says.
Before the surgery, Simpson weighed 21st 11lb.
She said she suffered from tiredness and sluggishness, and had problems sleeping. She was also told she was at risk of developing Type 2 diabetes.
With an active job as a hairdresser, she wanted to make sure she would continue to be able to do her job. She now weighs 12st 5lb.
“It has given me my life back. I was living in a shell, with no confidence. I was in a circle of eating for comfort and getting bigger and bigger. The problem gets bigger and it gets harder to get out of. The surgery has given me a new lease of life. I am not tired and it has been fantastic.”