Te Tai Tokerau Bariatric Surgery Programme

About Obesity and Bariatric Surgery

Obesity is a chronic issue, and there are many factors that contribute. In the past, obesity was viewed as the result of overeating and exercising too little – ‘If only a person would eat less and go for a run, the problem would be solved.’ This is not to say that healthy eating and exercise are not important in the management of obesity. They are vital tools but, all too often, inadequate for those who already have obesity.  

Many social, cultural, environmental, physical, psychological, and behavioural factors contribute to obesity. The world we live in is very obesogenic (meaning that it facilitates the development of obesity), which is reflected in the increasing rates of obesity worldwide. New Zealand has one of the highest rates of obesity in the world, with a third of our adult population having obesity. 

Our foods have become very high in calories, and our environment makes physical activity challenging. Our bodies also do not like us losing weight and try to defend against these changes. This concept is known as the body’s weight ‘set point’. A helpful resource that explains this is a YouTube video called ‘Time to Act on Obesity’ – google it. Surgery is a useful tool to help reset the body’s weight ‘set point’. It is a biological solution for a biological problem. 

Defining obesity is challenging. While not perfect, the internationally standardised definition uses body mass index (BMI). 
BMI = weight (kg)/height (m)²

Calculate your BMI

https://www.health.govt.nz/your-health/healthy-living/food-activity-and-sleep/healthy-weight-bmi-calculator

Overweight is defined as a BMI >25 kg/m² and obesity is defined as a BMI >30 kg/m²

Bariatric Surgery and Expected Outcomes

Bariatrics is a branch of medicine that specialises in the causes, prevention, and treatment of obesity. Bariatric surgery is a form of surgery that is designed to facilitate weight loss. The terms weight loss surgery, bariatric surgery and metabolic surgery are used interchangeably.

Many organisations, including the World Health Organisation, classify obesity as a chronic disease. Bariatric surgery is a major procedure and a life-altering event used to help people with obesity achieve better health, reduce chronic disease, and improve overall quality of life. The surgery intentionally alters your gastrointestinal tract to facilitate weight loss and reset your body’s weight ‘set point’.

On average, people who have bariatric surgery lose about 20-30% of their starting weight. It is normal to gain a small percentage of that back around the 18–24 month mark. This weight loss is significant and is usually associated with substantial improvements in obesity-related illnesses such as diabetes and sleep apnoea. A weight loss of as little as 5-10% leads to significant health improvement. Bariatric surgery doesn’t make you a ‘normal’ weight, but it does improve health. Managing expectations about bariatric surgery is an important part of surgery success.

Expected outcomes

• Weight loss – 20-30% of starting weight
• A high chance of remission in the following areas: diabetes, hypertension, fatty liver, arthritis, and sleep apnoea
• Improvements in energy, vitality, mental health, and sleep. 

The operation does not magically work, but rather, can be seen as a tool to use in your health improvement journey. Consistent physical activity post-surgery also helps to manage weight and has far-reaching health benefits independent of weight loss. To improve your health, you must commit to a lifetime of healthy lifestyle habits and follow recommendations of the bariatric team. 

The Te Tai Tokerau Bariatric Service offers two surgeries:

• Laparoscopic Sleeve Gastrectomy
• Laparoscopic Gastric Bypass.

It is important to educate yourself about both surgeries so you and your surgeon can talk about the best option for you. 

See “More Information” for links on weight loss surgery.

The Bariatric Surgery Journey

The actual operation is only part of your weight management journey. Our team of specialised health professionals will be privileged to support you before, during and for several years after your surgery. Before your surgery, you will work with the team members to prepare you for your surgery and ongoing lifestyle changes. This is a 6–12-month period designed to put in place the habits and changes required for long-term success. A treatment plan will be formulated alongside you.  

This will require your attendance at several clinic appointments and education sessions. Where possible, we try to provide these clinics and sessions online, over the phone or in the regional hospital closest to your home. However, this is only sometimes possible or appropriate, and there are still a number of occasions where a trip to Whangārei is required. It is compulsory to attend all appointments.

Before your operation, you must undergo some medical investigations, including a gastroscopy. You will also require blood tests both before and after surgery. In the weeks before your surgery, you will be prescribed a liquid diet (Opti-fast®).  

The operation is performed at Whangārei Hospital. You are in hospital for 2-3 days on average. Most people need a month off work as they adjust to their new way of life after surgery. Lifelong bariatric-specific multivitamins are required after surgery, which comes with a cost. Our team will follow you closely after your operation.

Again, where possible, we try to provide these clinics and sessions online, over the phone or in the regional hospital closest to your home. Two years after your surgery, we will hand over your ongoing healthcare to your GP.  

Is Surgery Right For Me?

We accept GP referrals for patients who have a BMI ≥ 35 kg/m² and associated obesity-related health issues. It’s important to remember that bariatric surgery needs to be performed safely and some medical conditions mean surgery is not possible. Unfortunately, the public health system is a limited resource, and we use a National Prioritisation Score to help identify those best suited to have publicly funded bariatric surgery.

If you are not accepted to our program but meet the above criteria, then we encourage you to investigate private options if this is an option for you. These are available locally and nationally, please speak with your GP or Nurse Practitioner (NP) about what could be available to you. We strongly discourage travelling internationally to have bariatric surgery as these facilities cannot provide the overall support required for a good outcome.

Meet The Team

We are a team of specialised professionals committed to assisting you through this stage of life. This is your life journey, and we are privileged to be able to partner with you at this time. We are here to support you before, during and for three years after your surgery. Your team will include your Bariatric Surgeon, Clinical Nurse Specialist, Dietitian, Psychologist, Anaesthetist, GP or Nurse practitioner, and administration staff. 

• Sean Liddle – Surgeon and Clinical Lead 

Sean is a New Zealand-trained General Surgeon specialising in upper gastrointestinal, bariatric, and minimally invasive surgery. Born and raised in New Zealand, Sean did his general surgery training throughout New Zealand. On completing this, he spent three years in Calgary, Canada, specialising in bariatric and upper GI surgery. Sean is well-versed in primary and revisional bariatric surgery and offers non-surgical weight loss treatments. When not working or being a dad, Sean enjoys going for a run, surfing or playing a round of golf.

• Dana Antunovich - Psychologist

Dana is a Health Psychologist and did her training at the University of Auckland. She was born and raised in Te Tai Tokerau and has worked at Te Whatu Ora – Whangārei Hospital since 2020. She aims to support you to be in the best place possible before surgery and to move with challenges as they may arrive on your journey with the service. He aha te mea nui o te ao? He tāngata! (What is the most important thing in the world? It is people!)

• Sarah Fallon – Clinical Nurse Specialist

Sarah is a registered nurse. She completed her training through the Greenlane Hospital School of Nursing in Auckland and has completed her Postgraduate Diploma in Health Sciences at the University of Auckland. She was born in Auckland and has worked in various clinical settings in senior nursing roles. Sarah has witnessed the positive impacts bariatric surgery can have for people and feels privileged to be involved in making this speciality a success in Te Tai Tokerau. Sarah and her family moved to Whangārei in 2017 and enjoy the “laid-back” lifestyle that comes with living in Northland.

• Jessica de Wit - Dietitian

Jessica has recently returned to Northland and the Te Tai Tokerau Bariatric service. She completed her Masters of Nutrition and Dietetics at the University of Auckland in 2015 with her thesis on high versus low protein diets for weight loss in patients awaiting bariatric surgery. Jessica previously worked at Northland DHB in Surgical, Intensive Care, Orthopaedics, and the Bariatric programme. She is passionate about nutrition and helping patients before and after surgery to meet their nutritional needs. Jessica loves baking, running with her dog and anything involving the outdoors.

How To Be Referred

You need to be referred to Te Whatu Ora in Te Tai Tokerau, for publicly funded surgery. Our service accepts referrals from General Practitioner (GPs) and Nurse Practitioners (NPs).  We recommend that you make an appointment with your GP or NP to discuss having this referral completed on your behalf.  There are certain criteria regarding the eligibility for publicly funded surgery.  Once we receive a referral, our team will review it and advise your GP/NP if you are eligible for surgery in the public system.  

More Information & Useful Links 

• Time to act on obesity – why is it so hard to lose weight?- [YouTube]
• Weight-loss surgery- [Health Navigator]
• Treat your Obesity - [American Society for Metabolic and Bariatric Surgery]
• Breaking Down Nutrition with Dr Susan Mitchell- [Nutrition Podcast (subscription required)]

Healthy weight BMI calculator
https://www.health.govt.nz/your-health/healthy-living/food-activity-and-sleep/healthy-weight-bmi-calculator

Australian & New Zealand Metabolic and Obesity Surgery Society (ANZMOSS)
https://anzmoss.com.au

International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO)
https://www.ifso.com 

American Society for Metabolic and Bariatric Surgery (ASMBS)
https://asmbs.org

Contact Details

Bariatric.clinic@northlanddhb.org.nz