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Surgery for Obesity

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22 Aug, 2018

Obesity in India has reached wide proportions in the 21st century affecting 5% of the country's population. India’s women are more likely to be obese than their male counterparts. A new research published in the British medical journal, The Lancet, shows that there were 20 million obese women in India in 2014 compared with 9.8 million obese men.

Obesity can be termed as a condition where excess body fat has accumulated to cause adverse effects on health.

BMI is a tool used to measure obesity which is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. It measures the body fat of a person's based on their height and weight.

BMI = Weight in Kg/Square of height in Meters = (kg/m2)

 

WHO (World Health Organization) range for BMI 

  • Underweight = <18.5
  • Normal weight = 18.5 to 24.9
  • Pre-obesity = 25.0 to 29.9
  • Obesity Class I = 30.0 to 34.9
  • Obesity Class II = 35.0 to 39.9
  • Obesity Class IV = Above 40

Obesity increases the risk of developing related conditions such as diabetes, hypertension, sleep apnea, high cholesterol, stroke, osteoarthritis, respiratory problems to name a few. Thus getting treatment to reduce weight to control obesity and its related diseases is highly important.

 

The Two Main Objectives of Obesity treatments are

  • Achieving a healthy weight.
  • Maintaining that healthy weight.

The first intervention for obesity is usually to encourage patients to change their diet to involve more natural foods and to exercise to burn excess fat. Some are prescribed medicines which help curb appetite and increase fat metabolism.  But as patients stop taking the medication, weight gain usually re-occurs. When these techniques fail, surgeons then recommend obesity surgery. Many people, who have been unsuccessful in losing the weight, opt for bariatric or weight-loss surgery.

 

Bariatric surgery refers to – various types of surgical procedures for weight loss opted by obese individuals to reduce their food intake, thus causing them to lose weight.

To be considered for weight-loss surgery, patients need to meet certain requirements:

  • BMI is at least 40 or,
  • BMI of at least 35 is accompanied by such diseases as diabetes, hypertension, arthritis limiting daily function, and cardiopulmonary failure.
  • Patient’s should also be able to understand the surgery and the consequences of the treatment, should comply with long-term follow-up,  agree to maintain vitamin and mineral supplementation, and report to their physician, any problems or complications arising after bariatric surgery.

 

There are three main bariatric surgery procedures that are widely used.

  • Gastric bypass – most commonly opted bariatric procedure in the world. In this procedure, the digestive system is re-routed past the stomach in order to suppress hunger and promote satiety.
  • Gastric banding- involves having an inflatable band placed around the top portion of the stomach, creating a smaller stomach pouch. A smaller stomach means eating less and the individual feeling full and their hunger is satisfied.
  • Sleeve Gastrectomy – This procedure involves the removal of about 80% of the stomach to create a smaller stomach pouch, which again reduces the amount of food consumed.

Bowel shortening procedures are irreversible while Gastric Band surgery can be reversed. Some bariatric surgical procedures are also performed laparoscopically (laparoscopic operations are performed through small incisions in the pelvis/abdomen with the help of a camera).

 

Benefits of Weight Loss Surgery

Many patients see a weight loss of 10 – 35% of total body weight within two to three years after the operation, depending on the chosen procedure. Many medical conditions which occur due to obesity, usually improve after weight loss surgery such as high blood pressure, high cholesterol, diabetes, joint pain, metabolic syndrome, sleep disorders and depression. Diabetes can improve quickly whereas high blood pressure may take a little longer. Cardiovascular risk factors are improved, and a reduction in mortality from 40% to 23% is also seen. In time, most people realize that their requirement for medicines decreases while some may not need any at all.

 

Risks and Side Effects

  • In addition to the complications of surgery and malnutrition, long-term effects can include reduced bone density and impairment in nerve function.  
  • Serious side effects can include bleeding, infection, leaks from the stitched area, and blood clots in the legs that can move to the heart and lungs. Most people don’t get any of these.
  • A common issue with Gastric Bypass is the Dumping syndrome, in this, the food moves too quickly through the small intestine causing nausea, weakness, sweating, faintness, diarrhea after eating, and not being able to eat sweets without feeling very weak. 50% of people who had weight loss surgery may suffer from this syndrome. This can be prevented by avoiding high-sugar foods and replacing them with high-fiber foods.
  • A fast weight loss can also cause the formation of Gallstones. Adding bile salt supplementation to the diet for the first six months after surgery can help prevent them.
  • Lifelong supplementation in the diet after as surgery is required for patients as long-term vitamin and mineral deficiencies occur.