Categories: General Health

What is Bariatric Surgery?

Bariatric surgery is a Gastrointestinal surgery to improve, prevent and/or treat obesity and its co-morbidities which may be life-threatening. This is a life-saving surgery and not a cosmetic surgery. The surgery is done by laparoscopy and does not involve the removal of fat from the body like liposuction. Weight loss after surgery is gradual i.e. 4-5 kgs per month and reaches a stable level after 1-2 years after surgery. Bariatric surgery is known to be the most effective and long-lasting treatment for morbid obesity and many related conditions, but now mounting evidence suggests it may be among the most effective treatments for metabolic diseases and conditions including Type-2 Diabetes, Hypertension, High cholesterol, Non-alcoholic fatty liver disease, and Obstructive sleep apnea.

Who is a candidate for Bariatric Surgery?

Patients who are morbidly obese (BMI > 40 kg/m2 or ≥ 35 kg/m2 with comorbidities), have failed attempts at diet and exercise, are motivated and well informed, and are free of significant psychological disease.

MYTHS ASSOCIATED WITH BARIATRIC SURGERY

Myth #1: Bariatric surgery is a very drastic step for a few people only, most obese will lose weight by diet and exercise.

Bariatric surgery has been proven beyond doubt to benefit the morbidly obese with BMI > 40kg/m2 (and with BMI > 35kg/m2 with any obesity-related disease) where no other treatment (including very low-calorie diet and exercise) has been proven to have a durable long term weight loss. Bariatric surgery is not for a cosmetic benefit like Liposuction but is indicated for people suffering from obesity and related diseases like Diabetes, Hypertension, etc.

Myth #2: Bariatric surgery is only for the morbidly obese.

Obesity is only one of the criteria that qualify patients for surgery. Overweight patients may also be candidates if they have one or more health problems that might be reduced or alleviated by weight loss. Diabetes, Sleep apnea, Hypertension, Arthritis, and High cholesterol are examples of such weight-related health conditions. Metabolic surgery is a term used for such procedures.

Myth #3: Bariatric surgery is a one-time weight loss solution.

Bariatric surgery helps in weight loss by restricting diet and mal-absorption of ingested food plus some hormonal changes reducing appetite. Dietary modification and following a healthy lifestyle after the surgery are equally important. Weight loss is gradual over 1-2 years and depends on many factors including individual compliance to dietary modifications. Continuous follow-up is required for the best results.

Myth #4: You should eat whatever you want now since you’ll be on a restricted diet after Bariatric surgery.

It’s much better to start getting used to your post-surgery diet before you have the operation. This helps you lose some weight beforehand and lessens your risk of complications. Plus, you’ll be better prepared psychologically for the diet changes that are coming up. Patients are typically placed on a liquid diet for a period of time prior to the surgery anyway, so that “last meal” of the night before just isn’t going to happen.

Myth #5: You will become very thin or physically weak after Bariatric surgery.

Most patients do not lose all of their excess weight. Excess weight is calculated by estimating the ideal weight for a particular height of a patient. Losing just 50 percent of excess weight and keeping it off is considered as a success story. So, a patient who is 50 kgs overweight before the surgery might only be 20 kgs overweight after they finish losing weight. That’s still going to be overweight in the eyes of most people. Plus, your skin isn’t necessarily going to tone up and be free of drooping after weight loss. However, the health benefits in reducing weight-related problems like Sleep apnea often occur even in patients who don’t lose all the weight they would like.

Myth #6: Weight loss from Bariatric surgery is permanent.

Unfortunately, even this one is not true. In fact, some regain is likely. A patient might lose 70 kgs and gain back 15 kgs to 25 kgs. Part of this is simply the body adjusting to the “new norm” and learning to store fat even on a very restricted diet. In the best case, some of the gains might be muscle from getting more exercise. At other times, a patient’s failure to adhere to the post-surgery lifestyle recommendations plays a role.

Myth #7: Bariatric surgery is reversible.

Gastric banding is usually reversible. That’s because the stomach and the intestines are not cut or stapled with this surgery. Gastric bypass may be reversible, but this is a very involved surgery. It’s more difficult to put everything back where it was, and there is a risk that the revision won’t restore the normal function. Sleeve gastrectomy and duodenal switch entail the actual removal of a part of the stomach without re-attaching it lower on the intestine. This type of surgery is not reversible.

Myth #8: After Bariatric surgery, you won’t be able to eat anything that tastes good.

Patients who undergo gastric bypass may need to avoid very sweet foods because it can cause side effects like dizziness and nausea. Patients who have a duodenal switch typically need to keep fatty foods to a minimum. However, many patients can and do eat their favorite foods after they recover from the surgery. They just eat very small portions. Even if you can’t eat whatever you like, you may find that Bariatric surgery provides you with the ideal opportunity to experiment and find new foods to enjoy.

Myth #9: Bariatric surgery has long term side effects or detrimental effects on fertility or newborn.

Obesity has major detrimental effects on every organ of the body and most morbid obese have greater chances of death at an earlier age than normal-weight people. Bariatric surgery has been shown to improve and provide longer life to patients suffering from obesity-related diseases. Most diseases like Diabetes, Hypertension, Sleep apnea, High cholesterol levels improve after the surgery or are cured. Bariatric surgery itself causes no detrimental effects if dietary supplements are taken as per the advice of the doctors. Infertility has been shown to improve both in men and women. Pregnancy is advised only after the target weight has been reached after 1-2 years after the surgery. There are no problems with the newborn child if nutritional advice is followed during pregnancy.

Dr. Saurabh Kalia, Surgical Gastroenterologist, Narayana Multispeciality Hospital, Jaipur

Narayana Health

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