Senior Consultant Surgeon & Deputy Head of Surgery at SKH. Leads Upper GI & Bariatric Service. Fellow of RCS Edinburgh & Glasgow and World Obesity Federation. PhD in Biomedical Engineering. Expert in surgical innovation and obesity treatment.
Pharmacotherapy
Clinician's Perspective: • Semaglutide is a GLP-1 (Glucagon-like Peptide-1) receptor agonist that mimics a natural hormone to regulate appetite and improve insulin secretion, making it a cornerstone therapy for both Type 2 Diabetes and chronic weight management. • Weight Reduction: Participants using 2.4 mg of Semaglutide
Pharmacotherapy
Clinician's Perspective: • Tirzepatide is a medication that targets two distinct hormone receptors: the Glucagon-like Peptide-1 (GLP-1) and the Glucose-dependent Insulinotropic Polypeptide (GIP). As a result, the stomach emptying is slowed down and appetite is reduced. • Dose-Dependent Weight Loss: Across clinical trials lasting 72
Bariatric Surgery
Clinician's Perspective: • The condition formerly known as Non-Alcoholic Fatty Liver Disease (NAFLD) has been officially renamed Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) to better reflect its origins in metabolic health. • MASLD in the general population has risen from 25% in 2016 to more than 30% today,
Understanding Obesity
Clinician's Perspective: What can't be changed (non-modifiable risks) • Genetic Predisposition: Research indicates that 40% to 70% of the variation in Body Mass Index (BMI) is attributable to genetic factors, rather than lifestyle choices alone. • Time in the Womb: The intrauterine environment (the environment inside the
Bariatric Surgery
Clinician's Perspective: • Hypertension (High Blood Pressure) is often present in persons with obesity. Effective weight management in the form of Bariatric Surgery may lead to improved Blood Pressure control. • In a randomized controlled trial looking into how Roux en Y gastric bypass affects High Blood Pressure management, at
Understanding Obesity
Clinician's Perspective: • Obstructive Sleep Apnea (OSA) is common amongst people with Obesity, however, OSA frequently occurs in non-obese individuals as well. • OSA is primarily driven by how the anatomy or shape of one's upper airway impairs air flow into the lungs. • Bariatric Surgery (weight-loss
Bariatric Surgery
Clinician's Perspective: • Hydration: Maintaining a daily fluid intake of at least 1 to 1.5 liters is important to prevent kidney complications and reduce symptoms of nausea and tiredness. • Protein: Consuming 60 to 100 grams of protein daily is mandatory to reduce the loss of muscle mass, which
Bariatric Endoscopy
Clinician's Perspective: • In patients who have undergone gastric bypass, Transoral Outlet Reduction (TORe) aims to narrow the Gastrojejunal Anastomosis (the surgical connection between the stomach pouch and the small bowel) using endoscopic suturing, slowing down gastric emptying. • High Efficacy: The procedure demonstrated a pooled clinical success rate of
Bariatric Endoscopy
Clinician's Perspective: • Durable Weight Loss: Patients undergoing Transoral Outlet Reduction (TORe) achieve a Total Body Weight Loss (TBWL) of approximately 8.4% at the five-year mark, effectively halting the upward trajectory of weight regain. • TORe focuses on narrowing the Gastrojejunal Anastomosis (the surgical connection between the stomach
Bariatric Surgery
Clinician's Perspective: • Mortality rates for bariatric procedures are statistically low, generally observed at less than 0.3% (approximately 3 in 1,000 patients) within the first 30 days. • Early Complications: Immediate post-surgical risks include Venous Thromboembolism (blood clots in the veins) and Anastomotic Leaks (leakage at the
Pharmacotherapy
Clinician's Perspective: • Researchers identified a specific genetic variant in the GLP1R gene (GLP-1 receptor) (the primary cellular docking site for these drugs) that directly influences how much weight a person loses. • Individuals carrying a specific version of this gene (rs10305420) experienced an additional 0.76 kg of
Understanding Obesity
Clinician's Perspective: • Insulin Resistance: 95% of patients with obesity and PCOS exhibit Insulin Resistance (a condition where cells fail to respond effectively to insulin), compared to 75% in lean patients. • Visceral Adiposity: Excessive internal belly fat is identified as the primary driver of metabolic dysfunction because it contains