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Weight Loss/Bariatric Surgery:
Is it worth the risks?

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1.What is Bariatric Surgery?

Bariatric surgery is nothing but the common term collectively used for many types of weight-loss surgeries. These surgeries make changes to your digestive system to help you lose weight. They either limit the amount of food you can intake or reduce your ability to absorb nutrition and in some cases both.

Such types of surgeries are done when diet or exercise plans have not worked out for the person and when the person has some serious health condition as a result of their weight. Gastric bypass is the most common type of bariatric surgery and most surgeons prefer this surgery as it usually has fewer complications than other weight-loss surgeries do.

These surgeries generally pose major risks and side effects and the patient has to make changes to their diet permanently and also schedule a fixed exercise regime so that they can ensure the lasting success of bariatric surgeries.

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2.Types of Weight Loss/Bariatric surgeries

Types of weight loss surgery
  • Biliopancreatic diversion with duodenal switch (BPD/DS).
  • Endoscopic sleeve gastroplasty.
  • Gastric bypass (Roux-en-Y)
  • Intragastric balloon
  • Sleeve gastrectomy

Biliopancreatic Diversion With Duodenal Switch (BPD/DS)

This weight loss procedure or process is said to be less common and has two major steps.

The initial step is also called sleeve gastrectomy where eighty percent of the patient’s stomach will be removed leaving a much smaller tube-shaped stomach. The pyloric valve which releases food to the small intestine still remains along with few portions of the small intestine which usually connects with the stomach. The second, as well as the final step, is to bypass the majority of the intestine to the duodenum which is situated near the stomach. These surgeries once done reduces the amount of food you intake as well as the amount of nutrient absorption is also limited which generally includes fats and proteins. This surgery is performed mostly together but rarely in fewer cases, they are performed as two major surgeries such as sleeve gastrectomy and once the weight loss starts the intestinal bypass is done. This procedure has more risks even though when the results are effective. And so to avoid any mishappens, this surgery is recommended for patients whose body mass index (BMI) is greater than 50.

Endoscopic Sleeve Gastroplasty

One of the latest types of weight loss surgery is endoscopic sleeve gastroplasty. In this procedure, the size of the patient's stomach is reduced with the help of the endoscopic suturing device. When a person's body mass index is 30 or above, as well as their diet and exercise plan, hasn’t worked out then this surgery is recommended. A significant loss of weight can be observed through the procedure of endoscopic sleeve gastroplasty as the surgery limits the food intake and moreover the operation is less invasive and the number of complications is also less.

Gastric Bypass (Roux-en-Y)

Gastric bypass surgery

Gastric bypass surgery is also called a Roux-en-Y gastric bypass. In this procedure, a small pouch that is in the stomach is connected to the small intestine directly. And so the food once swallowed pass from the small pouch of the stomach to the small intestine without passing through most of the stomach past and the initial portion of the small intestine.

This procedure is the most common weight loss procedure followed world-wide and as any weight loss surgery, this is also done when the diet and exercise plan doesn’t work out for the patient.

Intragastric Balloon

In this weight loss surgery a saline-filled balloon made of silicon is fixed in the stomach. This helps the patient to lose weight as the amount of food eaten is limited. And it makes the person feel full even with small portions.

Sleeve Gastrectomy

Sleeve gastrectomy is a surgical weight loss procedure also known as vertical sleeve gastrectomy. This surgery is done through laparoscopy method where small instruments are used to make multiple incisions on the upper stomach. Around eighty percent portion of the stomach is removed in this procedure. A small tube-shaped stomach which would the size and shape of the banana is left behind. Hormonal changes are induced in this procedure to help weight loss. These hormones not only reduce weight but also helps in relieving from conditions such as high BP or any typical heart disease related to weight issues.

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3.Is Bariatric surgery right for you?

Bariatric surgeries may not be suitable for everyone and so they are only performed if there is a serious health threat or impediment to the patient due to their excessive weight. It is not advised as a cosmetic procedure as there are serious risks and complications that may arise.

Biliopancreatic Diversion With Duodenal Switch (BPD/DS)

This procedure is done when the person has a high risk of potentially life-threatening health issues related to weight gain, such as the following:

  • Heart disease
  • High BP
  • High cholesterol
  • Severe sleep apnea
  • Type 2 diabetes
  • Stroke infertility

This procedure is not for everyone who is obese. And so screening processes are done to see if you are a suitable candidate for this surgery.

Endoscopic Sleeve Gastroplasty

This procedure is often used for candidates whose BMI is thirty and above. It is only recommended when even after trying to maintain their weight through exercise and diet they are unable to make any progress. The patient has to be willing to maintain a healthy lifestyle and go for a regular checkup and also participate in behavioral therapy to be considered as a candidate for this surgery. This procedure is not suitable for a person having gastrointestinal bleeding or hiatal hernia which is more than three centimeters or the person who had any previous abdominal surgery.

Gastric Bypass

The gastric bypass surgery is generally a suitable option for individuals whose:

  • Body mass index is forty or higher
  • BMI range from thirty-five to thirty-nine with health issues such as type 2 diabetes or high BP or severe sleep apnea
  • In some rare cases, the surgery is done when you have severe health issues even if your BMI is thirty to thirty-four

Intragastric Balloon

This procedure is generally recommended for people who:

  • Have a Body mass index between thirty to forty
  • Are willing to adopt a healthy lifestyle and participate in behavioral therapy
  • Have not undergone any previous stomach or esophageal surgery

Sleeve Gastrectomy

This procedure is generally recommended for people who:

  • Have Body mass index is forty or higher (extreme obesity)
  • BMI range from thirty-five to thirty-nine point nine with health issues such as type 2 diabetes or high BP or severe sleep apnea
  • In some rare cases, the surgery is done when you have severe health issues even if your BMI is thirty to thirty-four

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4.Risks and Complications of Bariatric Surgery

Biliopancreatic Diversion With Duodenal Switch (BPD/DS)

BPD/DS risk factors includes the following

  • Excessive bleeding
  • Infection
  • Adverse reaction to anesthesia
  • Blood clots
  • Lung or breathing problems
  • Leaks in the gastrointestinal system

Long-term risks are:

  • Bowel obstruction
  • Dumping syndrome
  • Gallstones
  • Hernias
  • Hypoglycemia or low blood sugar
  • Malnutrition
  • Stomach perforation
  • Ulcers
  • Vomiting

Endoscopic Sleeve Gastroplasty

This procedure is generally considered safer than other bariatric surgeries. Symptoms such as pain and nausea can be observed for several days which can be easily fixed by pain and nausea medicines. Mostly the people fully recover in two to three days. Although this procedure is not a temporary one by it is a procedure that can be reversed. However, as this surgery is quite a new procedure, the long term effects and risks are unknown.

Gastric Bypass

Risks such as excessive bleeding, infection, adverse reactions to anesthesia, blood clots, lung problems, and gastrointestinal system leakage are short term issue while bowel obstruction, diarrhea, nausea, vomiting, gallstones, hernias, hypoglycemia, malnutrition, ulcers, stomach perforation are a long term related health complications.

Intragastric Balloon

Intragastric Balloon surgery

One third of the people are affected by pain and nausea once after the procedure. But these symptoms are only for a few days which can be resolved through medication. Replacement for the intragastric balloon and their removal are quite rare. There is a possibility that the balloon could deflate and could move to the person's digestive system which could become a risk. And this causes the blockage which would need another surgery. Some rare possibilities such as ulcers or perforation of the abdominal might occur.

Sleeve Gastrectomy

  • Excessive bleeding
  • Infection
  • Adverse reaction to anesthesia
  • Blood clots
  • Lung or breathing problems
  • Leaks in the gastrointestinal system
  • Bowel obstruction
  • Dumping syndrome
  • Gallstones
  • Hernias
  • Hypoglycemia or low blood sugar
  • Malnutrition
  • Stomach perforation
  • Ulcers
  • Vomiting

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5.What results can you expect?

For each type of bariatric surgery, the results differ as follows:

Biliopancreatic Diversion With Duodenal Switch (BPD/DS)

There might be a possibility for seventy to eighty percent weight loss within the first two years. But the weight loss will completely depend upon the person's personal changes in their lifestyle. In addition to that, any other health issues which were related to obesity would be resolved.

Endoscopic Sleeve Gastroplasty

This surgery may result in a significant loss of weight. And in the studies, it has shown that 17.8 kilograms are reduced for the person with a thirty-eight body mass index in just six months and nineteen kilos in about twelve months ie. one year.

And about thirty-three kgs in a person who had a body mass index of forty-five within the first six months i.e. in just half a year. (These results are purely indicative and may vary from patient to patient.)

Gastric Bypass

This procedure helps with a long-term loss of weight. The amount of weight loss depends on the surgery as well as lifestyle changes. The person might show up to sixty percent weight loss in just two years after the surgery.

Intragastric Balloon

This surgery makes the person feel full even with much smaller portion sizes. Hence the person tends to eat less than earlier. There are also hormonal changes induced which control appetite. About ten to fifteen percent of weight loss can be observed in just half a year.

Sleeve Gastrectomy

This surgery shows major weight loss of up to sixty percent which can be maintained if the person changes to a healthy lifestyle, diet, and exercise.

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6.Does insurance cover it?

The treatment for bariatric surgery is quite expensive which may approximately be 2.5 to 5 lakhs (Purely indicative). The cost depends on several factors such as the following

  • Type of surgery opted
  • Surgeon’s fee
  • Chosen hospital
  • Instruments used
  • Consultancy
  • Anesthesia
  • Follow-up procedures

The insurance coverage depends upon the bariatric procedure selected by the person. Most companies accept claims for procedures that might have morbid obesity with life-threatening issues. If the person may provide any proof stating that the surgery is essential than the insurance amount can be claimed.

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7.How do I keep the weight off after bariatric surgery?

The success of Bariatric surgery largely depends on the behavioural and lifestyle changes that the patient adopts after the surgery. Patients have to rigorously follow the diet plan prescribed by the dietitian and and also attend behavioural therapy to change their attitudes towards nutrition and exercise.

Diet Before Surgery

Your Bariatric surgeon might prescribe a weight loss goal and a plan that you have to achieve before the surgery. This weight loss helps in reducing excess fats around the liver as well as the abdomen region reducing the chance of complications. If you do not hit the prescribed weight goal, the doctor might choose to delay the procedure.

Diet plan (Pre surgery)

The guidelines may vary from person to person and also depending upon the type of surgery:

  • Avoid binge eating
  • Eliminate high sugar beverages
  • Daily multivitamin supplements may be recommended
  • Protein supplements may be recommended
  • High carbohydrate foods must be avoided
  • Eliminate saturated fats from your diet

Diet Plan (Post Surgery)

The diet plan after the surgery may go on for several stages which would be fixed by your doctor or dietician.

Stage 1: Liquid Diet

For initial days after the surgery only few ounces of clear liquids are allowed. After that, there will be graduate changes of which type of liquids can be taken.

  • Skimmed milk
  • Thin soup and broth
  • Decaffeinated tea or coffee
  • Unsweetened juice
  • Sugar-free gelatin

Stage 2: Pureed diet

Pureed food consists of food of a thick, pudding-like consistency which may be blended at home itself. Spices might irritate the stomach so it would be better to avoid them completely.

Mostly prefer seedless fruits and also avoid fibrous vegetables. Fruits such as bananas, peaches, apricots, pears, pineapples, melons are generally recommended at this stage. The dietician may also prescribed pureed vegetables such as tomato, spinach, carrots and green beans.

Stage 3: Soft diet

At this phase the doctor will suggest that you start with soft and easily chewable food. This may include:

  • Soft-boiled eggs
  • Ground meat
  • Cooked whitefish
  • Canned fruits
  • Yogurt
  • Whitefish
  • Cottage cheese
  • Ricotta cheese
  • Beef (Ground)
  • Chicken (Ground)
  • Turkey (Ground)
  • Scrambled eggs

Stage 4: Stabilization

In this stage, we can reintroduce solid food in our diet. This stage basically starts only after 2 months. The food should be broken down into small pieces and chewed well as your stomach is smaller. It is better to introduce food slowly so that the tolerance of your stomach can be noted and the diet can be adapted to not cause any discomfort.

Foods to avoid in stage 4:

  • Popcorn
  • Tough meat
  • Fried food
  • Crunchy food
  • Dried food
  • Bread products

Guideline for post op diet

After your surgical procedure, you will have to follow certain lifelong guidelines and adapt your lifestyle. It is best to prepare your meals at home and carry them with you at all times to avoid unhealthy binge eating.

Here are the guidelines you will have to follow lifelong after the procedure.

  • Eat and drink slowly and pace yourself at each meal
  • Portion control is essential
  • Listen to your body if it shows any signs of discomfort
  • Eliminate foods rich in saturated fats
  • Avoid beverages during meals especially sweetened ones
  • Be hydrated throughout the day
  • Chew food thoroughly and break it down to smaller pieces

Lifestyle changes after the surgery

Do not start your exercise program immediately after the surgery. Let your body heal and so go slowly. Low impact exercise is recommended in the initial months. It may include tasks such as walking, swimming, simple yoga, stretching, and deep breathing exercises.

Strength training and cardio workouts can be started only after consultation with the doctor.

Even simple changes in day to day life can be beneficial such as

  • Walking
  • Avoid sitting for long periods of time
  • Stretching at work
  • Taking stairs instead of the lift

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8.How to deal with loose skin after the procedure?

Maintain muscle mass: The better way to stop the excess skin is to build your body strength. The skin expands not only when a person gains weight but also when they gain muscles. Maintaining the muscles can help prevent excess loose skin from developing. Exercises such as standard bicep curls, squats and deadlifts can help in this. (However, this must be attempted only after getting a clearance from your doctor).

Cardio exercise for burning fat: Once the surgeon clears you for exercise start immediately with your cardio exercise. Walking is the best beginning cardio exercise and as your body heals shift to other exercises such as running, swimming or cycling.

Maintain diet: Include food items which help in reducing the development of excess skin. Specific food help in promoting healthy skin and also help in muscle growth. Focus on food items such as cashews or almonds or brazil nuts. Fruits such as berries and whole grains can also help.

Stay out of the sun: Too much sun is not at all good for people trying to work on their sagging skin after the procedure. Skin strengthening proteins may be diminished due to excess sunlight.

Surgical removal of the excess skin: Several different surgeries are used to remove extra skin, these are purely cosmetic procedures and are the prerogative of the patient:

  • Facelifts - Helps remove the sagging skin in the mid-face, jaw, and neck.
  • Breast lifts - Sagging breasts are lifted up.
  • Tummy tucks - Excess skin in the stomach area is removed.
  • Lower body lifts - Sagging skin in the stomach, buttocks, inner and outer thighs are removed.
  • Medial thigh lifts - removing the extra skin in the inner thigh region.
  • Arm lifts - Skin and excess fat hanging from upper arms is removed.

These surgeries are purely cosmetic and help with body image issues that may develop after the surgery. However, it is essential to consult doctors about whether these procedures are safe for you. It is also essential that you attend psychological counselling and behavioural therapy to build your confidence and deal with body image issues that may crop up.

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9.Bariatric Surgery FAQs: All your concerns addressed

Who needs bariatric surgery?

It is an alternative for people who are unable to lose their weight through a normal diet or exercise plan. And the surgery was recommended by surgeons to people who have a body mass index of 40 or more. Even people with serious weight-related diseases such as sleep apnea, high blood pressure may be suitable candidates for these procedures.

How do I claim insurance for bariatric surgery?

Specific conditions have to be met for you to be able to claim Bariatric surgery under your medical insurance. Ensure you check with your insurance provider in detail about their specific requirements and policies.

  • Several test and authorization from the surgeon may be requested
  • Medical reports may be requested
  • Your Body mass index should be above 40
  • For a lower Body mass index, you can claim an exception due to serious health issues such as Type 2 diabetes, heart-related conditions, etc

How much does bariatric surgery cost?

The treatment for bariatric surgery is quite expensive which may approximately be 2.5 to 5 lakhs. The cost depends on several factors such as type of surgery opted, Surgeon’s fee, Chosen hospital, Instruments used, Consultancy, Anesthesia, and follow-up procedures. (Treatment cost is purely indicative and varies from case to case)

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