SOUTHERN WEIGHT LOSS NZ

A plan is key to weight loss surgery

Finance Options - Southern Weight Loss and Laparoscopy Limited Weight loss surgery may be for you, If you have struggled with excess weight and Yo-Yo dieting with extended periods of weight loss & gain

https://www.odt.co.nz/features/sponsored-content/gastric-bypass-surgery

Gastric Bypass Surgery Southern Weight loss & Laparoscopy is the Dunedin based surgical practice of Mr Mark Grant.

How much does Weight Loss Surgery cost?

At Southern Weight Loss and Laparoscopy we understand that you are making a significant financial investment in your physical and emotional wellbeing.

We believe in being transparent in the costs of your surgery. Evidence has shown that safe and successful outcomes require a close follow-up program with your surgeon and dietician.

So, for the first two post-operative years, all follow-up appointments are included in the packages offered.

Initial/ preoperative appointments are not included in the package deal.
Initial Appointments (GST inclusive):
• Surgeon consultation: $345
• Surgeon review (if required): $185
• Dietitian consultation: $150
• Psychologist consultation (if required):

Listed below are estimates for packages we offer at Southern Weight Loss & Laparoscopy. These estimates cover the cost of one night stay in hospital for the operation, i.e. the charges from the surgeon, anaesthetist and hospital itself. Also included is your follow up for 2 years with your surgeon and dietician, along with all blood tests. All estimates are inclusive of GST.

Procedure Fixed Price (inc GST)

Sleeve Gastrectomy $19804.25

Mini Gastric Bypass $22450.00

Roux-en-Y Gastric Bypass $24260.60

If you stay in hospital for additional nights, you will be charged an additional $780 (incl. GST) per night by Mercy hospital.
Your follow up appointments with your Surgeon and dietician will occur at:
• 4- 6 weeks, then
• 4 months
• 8 months
• 12 months
• 18 months and
• 24 months post-surgery.

The pre- surgery education session with your dietitian is also included in your package. However, you will need to purchase your pre-surgery Optifast meal replacements from your local pharmacy
If you are struggling after surgery additional 60-minute sessions with our dietitian are available and cost $ 90.

There may be additional costs if you need other procedures at the same time such as your gallbladder removed, or a Hiatal hernia repaired.

Some insurers may contribute to the cost of surgery. Please check this with your insurance company. We are happy to write to your insurer on your behalf. Financial assistance is also available through Nova Medical Finance.

Metabolic Syndrome

Metabolic syndrome describes a group of conditions that increase your risk of heart disease, stroke and diabetes. The conditions include high blood pressure, resistance to insulin, abnormal cholesterol levels, and obesity with excess body fat around the waist. If you have three or more of these conditions your risk of developing Type 2 Diabetes Mellitus (T2DM), is five times greater, than individuals without metabolic syndrome. Metabolic syndrome, is on the rise in New Zealand

Lifestyle changes and medications can help delay or prevent the development of serious medical conditions.

Implications of Metabolic syndrome

If you have metabolic syndrome, you are five times more likely to develop T2DM or Ischaemic heart disease, than someone without it.

Type 2 diabetes

If lifestyle changes fail to control your excess weight, you may develop insulin resistance, which may lead to T2DM. One of the most important health benefits of losing weight is improvement of T2DM. As it can increase your risk of heart disease, kidney and nerve damage, which can even lead to limb ulcers and amputations.

Heart and blood vessel disease

High cholesterol and high blood pressure can contribute to the build-up of fatty plaques in your arteries. These plaques can narrow and harden your arteries, which can lead to a heart attack or stroke.

How is it diagnosed?

If you have at least one component of metabolic syndrome, ask your GP to check for the other conditions. Blood pressure, cholesterol, triglyceride, weight, and glucose levels can all be checked by your GP. A diagnosis of metabolic syndrome requires three of the following conditions to be present:

• Abdominal Obesity with an increased waist circumference
Men >102cm
Women >88cm
• Elevated triglycerides
• Reduced HDL cholesterol
• High blood pressure
• An elevated fasting blood sugar, or you are already receiving treatment for high blood sugar

Causes
Metabolic syndrome is associated obesity, in particular excess fat around the waist.
It's also linked to insulin resistance. Normally, your gut breaks down your food into glucose. Insulin helps glucose move into your cells where it is used as fuel. If you have insulin resistance, your cells don't respond normally to insulin and glucose can't easily enter your cells. This leads to high glucose levels despite your body making extra insulin. Obesity leads to insulin resistance and this compensatory hyperinsulinemia (high insulin levels). Most people with insulin-resistant are able to maintain the degree of hyperinsulinemia required to prevent failure the body’s glucose control. If pancreatic insulin secretion fails to increase adequately, impaired glucose tolerance or T2DM develops.
Reducing your risk of metabolic syndrome

Diabetes and Diet

Eating well means you choose how much and what you eat. To both prevent and treat T2DM, a diet rich in vegetables, with moderate protein, and low-sugar fruits such as berries is recommended. Small amounts of healthy carbohydrates such as whole grains and legumes (Lentils, peas, chickpeas, beans, and soybeans) also play a role. Please limit or avoid sugar and processed foods, including those made with refined (white) flour. Also, avoid smoking and limit your alcohol intake.

At Southern Weight Loss & Laparoscopy we recommend that you work with a Registered Dietitian (RD) such as Helen Gibbs when developing a diet. Helen has an active interest in the management of T2DM. She can assist with personalized eating plans, including, what, when and how much to eat, which can make an enormous difference to your ability to control and manage your T2DM.

Diabetes and Exercise

To combat diabetes, we advise at least 30 minutes of exercise five days a week. You can do physical activity deliberately, by going for a brisk walk or to the gym. You can also plan it into your day with easy lifestyle changes. Such as:
• Parking your car further from your destination so you have to walk
• Take the stairs two or three flights instead of the lift
• Get off your bus two stops early and walk from there

If you want to lose weight though, you will probably have to ramp up your efforts to an hour or more of exercise at least five days a week. Healthy eating and physical exercise need to become habits, and once they are, they will benefit you for life. If you are ready to make a lifestyle change, including bariatric surgery to meet your weight loss goals and improve your health, request an appointment at Southern Weight Loss & Laparoscopy. We will lay out your options and help you choose the surgery or weight loss method that’s best for you and your life.
Treatment
Lifestyle changes and medication can help improve all of the individual components of metabolic syndrome. However, as can be seen in the picture. Obesity plays a central role in all of the risks factors for Metabolic syndrome. Even losing as little as 5% to 10% of your total body weight can lower your blood glucose and pressure levels. You may ask your GP to refer you to a dietician, such as Helen Gibbs at www.dietconsulting.nz, who can help you with meal planning and healthy food choices.
Stop smoking. Smoking contributes to high blood pressure and increases insulin resistance. There are many smoking products and resources that your GP can recommend to help you quit smoking.

Attend all of your appointments to help your GP monitor your condition. If lifestyle changes alone do not resolve your conditions, medications may help. Your doctor can prescribe medications to treat high cholesterol, high blood pressure, high blood sugar, and weight loss.

If lifestyle changes and medication fail to adequately control your metabolic syndrome then you may be a candidate for Bariatric surgery, so you should discuss this with your GP and ask for a referral to a Bariatric surgeon such as Mr Mark Grant at Southern Weight Loss & Laparoscopy or contact us at: [email protected].

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Making a healthier life a reality Southern Weight Loss & Laparoscopy is the Dunedin based surgical practice of Mr Mark Grant and we cover Otago and Southland. Currently Mark is the...

Obesity and infertility

Obesity and infertility are very closely linked.

Insulin resistance is prevalent in the obese population. This is thought to be a significant factor for a lack of an egg production (anovulation) by the ovaries, and therefore infertility. Elevated levels of intra-abdominal fat are known to produce the male hormones, known as androgens. These in turn prevent maturation of eggs in the ovaries and contributes to anovulation.
Studies have shown that with BMI’s above 31, women have a 170% higher chance of having infertility issues secondary to anovulation, when compared to women of normal weight.

Once pregnancy occurs, women with high BMIs are at higher risk for gestational diabetes, high blood pressure and miscarriage.
In another study evaluating women with a high BMI, but also had normal ovulation, it was shown that women with a BMI over 40, were 43% less likely to get spontaneously pregnant . It also demonstrated that women with high BMIs required higher doses of infertility drugs in order to achieve pregnancy.

On the basis of studies at least 60 – 70 % of women with high BMIs, who have struggled to get pregnant prior surgery, become pregnant after weight loss surgery because the obesity is a significant underlying cause their infertility.

After weight loss surgery, risks associated with pregnancy are reduced. This is because obesity increases the risk of foetal macrosomia, caesarean section, maternal gestational diabetes and eclampsia. So, when the mothers weight falls, the risks of these occurring also reduces.

Pregnancy is not recommended with in 18 months of weight loss surgery, because during that time your calorific intake is very low and you are at the greatest risk of micronutrient deficiencies, which could affect your baby’s development. The best time to get pregnant is when your weight loss plateaued. Before you consider trying to conceive, we recommend to that you make contact with a dietitian and have blood tests to assess your nutritional status.

Absorption of oral contraceptives might not be effective after surgery. It is therefore recommended to use alternative options, e.g. transdermal patches or intrauterine devices.

WHAT IS GASTRIC BYPASS SURGERY?
Gastric bypass surgery has been performed for over 50 years and is the benchmark against which other weight loss interventions are compared. This form of surgery not only reduces how much patients can eat, but patients also do not to feel as hungry after surgery, because it interferes with hormones that control appetite.

WEIGHT LOSS AFTER GASTRIC BYPASS SURGERY:
After 12- 18 months, weight loss ranges from 65-80% of your excess weight before surgery, which in many cases the is well maintained. So, on average, a typical patient who is 50 kilograms overweight will lose 32.5 – 40 kilograms.

HOW IS IT PERFORMED?​

Using key-hole surgery, a small pouch is formed from the top of your stomach which limits your meal size to about 50mls. A limb of small intestine is then joined to this stomach pouch, so that rest of the healthy stomach, which has not been removed, and the first 100 – 150cm of small intestine are bypassed. Your digestive enzymes are still able mix with your food, and enable nutrient breakdown and absorption, this just occurs further along the bowel than before surgery.

Patients stay in hospital two nights and will usually return to work within two weeks. However, each patient is different.

contact us at www.southernweightloss.co.nz

Check out our latest blog at: https://southernweightloss.co.nz/2021/03/30/reconstructive-surgery-after-weight-loss/

RECONSTRUCTIVE SURGERY AFTER WEIGHT LOSS
When you gain weight over a long period of time, your skin expands around your growing body. After weight loss surgery, you may lose in excess of 40 to 70 kilograms. As a result, your skin usually doesn’t have enough elasticity to recover from the prolonged extensive stretching. This may leave you with excess, sagging skin and residual fat. This excess skin often results in more than just cosmetic issues. It can prevent you from fully enjoying your healthier life.
It may result in:
• Postural problems
• Chafing, and rashes, especially when it rubs against other folds of skin or when it stays moist Infections, as loose skin creates folds that are harder to clean, and chafing causes breaks in your skin, paving the way for infections
• Unpleasant body odour due to moisture trapped in skin folds
• Body-confidence issues due to embarrassing or uncomfortable folds of redundant skin

There are many ways to reduce the amount of loose skin you may develop after surgery including:
• Balanced diet with plenty of protein and vitamins
• Exercise
• Cosmetic surgery (if none of the above are enough)
A balanced diet:

Eating sufficient protein may help you build and maintain lean muscle. It may also help to improve your skin elasticity, so it can fit more tightly to your new frame. After bariatric surgery, it’s important to eat at least 60 – 100 mg of protein a day. Taking your prescribed multivitamins may also preserve some skin elasticity after weight loss surgery. Vitamins C, A, E, K, and B-complex vitamins, as well as trace minerals such as zinc, are all important for skin health.

Exercise:

Exercise can limit the amount of loose skin you may develop after bariatric surgery. When you prevent the loss of lean muscle mass, you reduce the looseness of your skin. When you gain muscle, you actually fill out your skin more.

POST WEIGHT LOSS SURGERY OPTIONS

Doing all of the above will help, but the fact is that after losing 40 to 60 kilograms, it is realistic to expect that you will still have some excess skin. There is a range of surgical procedures that for the treatment of excess skin in the most commonly affected areas, which include the upper arms, back, breasts, abdomen and thighs. Together these excess skin and fat reduction surgeries are often known as body contouring surgery. They are only recommended after 18 months once your weight has plateaued.

ABDOMINOPLASTY

After weight loss surgery many patients will require removal of excess skin, especially in the abdominal area. The common term "tummy tuck" is technically known as abdominoplasty. In an abdominoplasty of the skin between the p***c hair line and the belly button being removed as an ellipse to improve the appearance, shape and profile of your abdominal area.

• Surgery usually takes approximately two hours
• Up to 10 kilograms or more of excess skin and tissue may be removed
• Average 2-3 days in hospital
• Patients frequently go home with drains.
• It can usually take up to 2 weeks to resume light work and 3-4 weeks to return to more physical activities like exercise
• Your scar may take up to a year or more to mature
• You may see dramatic changes your body contour, mobility, and clothing fit

Abdominoplasty is best done when weight loss has been stable for 12 months

THIGHPLASTY OR THIGH LIFT SURGERY
Thighplasty is a surgical procedure to remove excess skin and fat from the inner or outer thighs after excessive weight loss. It removes lax skin and fat and places the scars in the inner thigh area where it can be hidden.
• Excess skin is removed from the inner aspect of the thigh using incisions around the groin, upper leg and hip
• Liposculpture is often used in combination with Thighplasty
• One to two days in hospital
• Most patients return to work within one to two weeks
• Support garment is usually needed for 2-3 months
• Restricted activity for a few weeks

BRACHIOPLASTY OR ARM LIFT

This operation is done to tighten the loose skin of your upper arm and involves removing sections of skin from the inner arm.

• The scar usually starts in the armpit and extends down towards the elbow. Most of the time the scars are very fine after surgery, though in some patients they can widen
• Liposuction maybe performed at the same time with this procedure in order to shape your arm correctly
• It is also usually performed on both arms during a single operation. This means recovery time will be shorter than a secondary operation
• Recovery varies between patients, but most will need a few weeks off work and avoid activities that require lots of arm use
• Compression garments are usually worn for up to 12 to 16 weeks, by which time most of the healing has occurred

There are a number of talented plastic surgeons who offer body contouring in the Otago region including:

Mr Will Mcmillan
Rebecca Ayers
Mr Patrick Lyall:

There are many misconceptions about Bariatric Surgery. One that is often shared is that it’s a waste of time because you will just put the weight back on.

Truth: Studies have repeatedly shown that not only do patients who have had bariatric surgery lose more weight than those who only exercise and diet, the weight loss is maintained.

A Swedish study compared the 20 year outcomes of obese patients who underwent surgery, with those managed by diet and exercise alone. Those who had surgery lost more weight and were able to maintain their weight loss. They also had lower incidences of diabetes and cardiovascular disease, and more importantly they lived longer.

It must be remembered that surgery is just a tool; it’s only the beginning

We love this write up of the mural our surgeon Mr Mark Grant commissioned in St Clair.

https://www.odt.co.nz/news/dunedin/vibrant-addition-dunedin%E2%80%99s-street-art

WHAT CAUSES OBESITY

At Southern Weight loss and laparoscopy, we know that it is not your fault. Contrary to the commonly held belief carrying excess weight is not due to a lack of will power and being lazy. It is a metabolic disorder.

Obesity results from a combination of factors including:

• Genetics
• Emotional/Psychological trauma
• Behavioural
• Physiological
• Metabolic factors
• Environmental and Sociocultural influences,
• Poor dietary habits.

In fact, excessive food intake plays a small role the obese person's dilemma. A more important factor may the efficient storage of calories as fat. Differences between obese and non-obese individuals in regard to heat production and energy expenditure have been documented.
Studies have shown that:
• For weight maintenance an ex-obese person requires 25% fewer calories than a person of the same age and weight who has never been obese.
• For all levels of activity, an ex-obese required 15% less energy than a non-obese person.

Decreasing physical activity may also contribute to continuous weight gain.

Since multiple members of a family may become obese, this pattern of food processing by the body may have a genetic basis.
In New Zealand at least 31% of the adult population is considered obese, and at least an additional 35% are considered overweight.

For many people suffering with obesity diet and weight control programs have proven unsuccessful time and time again. Often, the frustration of repeated failed attempts at weight loss can result in even further weight gain. At Southern weight loss and Laparoscopy, we aim help you to finally break this cycle, and regain control of your weight and your life.

WEIGHT LOSS SURGERY IS JUST THE BEGINNING

EXERCISE.

After weight loss surgery, it’s important to make a habit of regular exercise. It will help you achieve your goal of a healthier life.

The benefits of exercise include:
Increasing your energy, strength and muscle tone
Help your joints stay loose and improve your posture
Improve your sleep, circulation, heart and lung function
Provide an outlet from the stresses of everyday life.
Above all it can help you feel good.

Any form of physical activity will use calories, and you can learn how much exercise you need to balance the number of calories you consume. We recommend that you exercise for 30 minutes at least 3 times per week for good health, but you may prefer to do more for good fitness and weight maintenance.

One great advantage is that while you are exercising you are often distracted from food. So, exercising when you would normally be snacking can help to break this habit, and reduce your food intake. You may find this particularly helpful in the evenings. Especially if you are in the habit of eating whilst watching TV. Food and television often go hand-in-hand. So by exercising not only are you reducing your food intake, you are decreasing your inactivity and gaining health life.

WHAT IS OBESITY?

Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to your health.

In medical terms obesity is defined as a Body Mass Index of over 30kg/m2.
Obesity is no longer considered to be caused by a lack of self-control, and excessive calorie intake. The World Health Organization has classified obesity as a chronic progressive disease resulting from multiple environmental and genetic factors.

WHAT IS THE BODY MASS INDEX (BMI)?

Your body mass index (BMI) generally reflects the amount of excessive body fat you have, although there are certain exceptions, such as the BMI of athletes, body builders or pregnant women.

BMI takes into consideration your height and weight, and is calculated using following formula or the calculator below:

Weight in kilograms divided by Height in meters squared (BMI = kg/m2)

Body size categories using BMI are based upon the ranges of BMI associated with a certain risk for mortality.

The categories and respective BMI categories are:​

Ideal weight
18.9 to 24.9

Overweight
25 to 29.9

Class I, Obesity
30 to 34.9

Class II, Serious Obesity
35 to 39.9

Class III, Severe Obesity
40 and greater

IS WEIGHT LOSS SURGERY RIGHT FOR YOU?

Many of us have asked ourselves this question.

So, weight loss surgery may be appropriate for you:

If you have struggled with your excess weight and have gone through a process of Yo-Yo dieting with extended periods of weight loss and weight regain. If so, you are not alone. Evidence has shown that up to 95% of diets fail, with people regaining their lost weight shortly after losing it.

Successful weight loss surgery can improve your self-esteem. It can enable you to find an improved level of confidence, positive feelings and control over a life that may have been an issue with being overweight for a long time.

Long term effects of any weight loss procedure are reliant on patients making the necessary changes to lifestyle, particularly in relation to diet and exercise.

IN ORDER TO BE ELIGIBLE YOU MUST:

- Be over the age of 18
- Have a Body Mass Index (BMI) of 35 to 39 with obesity related health problems previously described.
- Have a Body Mass Index (BMI) of 40 or above, with or without obesity related health problems previously described.

IDEALLY HAVE:
- Demonstrated a full commitment to achieving control of your weight
- A genuine desire to overcome your obesity related problems and
- An informed knowledge about both the benefits and the risks of weight loss surgery

Meet Our Dietitan

HELEN GIBBS
NZ REGISTERED DIETITIAN

Helen is a NZ Registered Dietitian, who has a specialist interest in weight management and Type 2 diabetes. She is also the owner and principal dietitian in Diet Consulting.

ABOUT HELEN AND HER ETHOS.

Helen was fortunate to study at Otago and describes her journey to studying dietetics as “scenic”. Undertaking a qualification in food science along the way. She moved to the UK working as both a community and a primary care dietitian. Working closely with the obesity services, often in a role of outreach and patient advocacy. Helen developed a strong interest in the research around weight bias and discrimination and their negative impact on health.

In New Zealand, she has worked in primary care, providing education to health professionals on nutrition and weight bias. Her private practice was first established in Auckland in 2004 . This second iteration is now based in Dunedin after Helen returned to New Zealand to be close to her family in 2014.

Helen and her partner currently live with her Mum, who is a also retired dietitian. Her partner has blessed her with two adult step daughters. They are all managed by a Tripaw cat called Jack.

About the Practice:

Meet Our Surgeon.

MR MARK GRANT
MBBS MMEDSCI FRACS

I am an Upper Gastrointestinal surgeon who passionate about the management of obesity and cancers of the stomach and oesophagus.

I graduated from the Imperial College School of Medicine, London. Successfully completing my General Surgical training in New Zealand. Becoming a Fellow of the Royal Australasian College of Surgeons (FRACS) in 2013.

I completed subspecialty training in Oesophagogastric surgery at the University Hospital Southampton. Specialising in the management of benign and malignant conditions affecting the oesophagus and stomach.

I worked as a Consultant Oesophagogastric Surgeon at both the University Hospital Southampton and the Queen Alexandra Hospital, Portsmouth.

However, I missed New Zealand so much that I returned in 2017, completing my Bariatric training at Waitemata DHB. Performing both primary and revisional bariatric procedures. Dunedin has always had a place in my heart having played rugby for Green Island as a student. I am now loving living by the beach with my chocolate Laborador, Molly.

Currently I am the only Upper Gastrointestinal and Bariatric surgeon appointed at Southern DHB.

I am very happy to have started consulting out of Suite 6, at the Marinoto clinic, and operating at Mercy Hospital.

I have always aimed to provide a high standard of care with an informative patient focus. My website has been design as a information resource for patients.

Please feel free to contact Suite 6, if you require any further information or would like to arrange an appointment with me, Mr. Mark Grant.