Senior Consultant Surgeon & 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.
Understanding Obesity
Clinician's Perspective: • Circadian rhythm is the term used to describe our bodies' relationship with the day cycle. • Biological Synchronization: Every cell in the body contains an autonomous molecular clock that orchestrates gene expression to ensure that Lipogenesis (the metabolic process of fat formation) and energy processing coincide
Understanding Obesity
Clinician's Perspective: • During Intermittent Fasting (IF), a person's dietary pattern will cycle between periods of eating and fasting. The four main styles are: Time-Restricted Eating (TRE), The 5:2 Diet, Modified Alternate-Day Fasting (MADF), and Alternate-Day Fasting (ADF). • Evidence reveals that Intermittent Fasting
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