January 2001 I arrived in a freezing cold Lyon excited to start my band training. I found the radiology department very full. We had 40 patients for band adjustments that morning. I was shocked. I had never really seen anyone overweight in Lyon yet there were 40 here today. I soon discovered that being overweight was considered to be highly unacceptable so many did shopping in the evenings due to criticism from other shoppers!
At this point I realised how little French I remembered. I had a baptism of fire and managed to develop a technique. This was the first of 4 busy adjustment sessions. I saw many successful patients and was impressed at how much their lives improved. The operation was funded by the French NHS and seen to be a medical rather than cosmetic procedure. Even normal weight people had heard of “l’anneau gastrique” and none seemed to see it is anything other than mainstream-completely different to my experience in the UK.
I returned home and started my own service in a private hospital. Several EU surgeons contacted me and asked if I would support their patients too. I had no idea there were so many. Few had wanted to go overseas. They simply could not afford the UK cost or couldn’t find a surgeon close to home. Many were left with no support in the UK. Understandably UK surgeons didn’t want to take responsibility for the surgery of another. This left patients in a difficult position in an emergency.
I continued with my clinics and also incorporated other operations. I started to work with NHS teams too. I wondered how we could help people with a BMI below the surgery threshold and those who had stopped losing weight despite having had surgery. Surgery was not often an option and there were few drugs available. Reductil ® (sibutramine) was an SSRI used to suppress appetite. Accomplia ® (rimonabant) had been quite effective with smoking cessation and showed promise with weight-loss. They were both quite expensive and GPs were reluctant to prescribe. The only alternative was Xenical (orlistat) which caused oily diarrhoea if patients weren’t very strict with the fat intake. Unfortunately, rimonabant was withdrawn from the EU market in 2007 with sibutramine withdrawn in 2010. Both associated with hypertension and cardiac problems.
There are just 3 drugs available in the UK to assist with weight loss. Orlistat is the only one available on an NHS prescription. One of the newest drugs was originally designed to treat type 2 diabetes but has been shown to be effective in encouraging weight loss when used at a higher dose. It is available via private prescription
The sad reality is that the battle to reduce weight and maintain weight loss continues forever and that there are no quick fixes.
Written by Toni Jenkins ( ECG Obesity Specialist Nurse), Friday 23rd October 2020
