What is Bariatric Surgery?

We live in weight-obsessed times. However, for some of us weight moves beyond the realm of obsession and becomes a reality. Gitanjai Grewal was one of those, until she opted for bariatric surgery. She was waging a losing battle with weight. The weight loss clinics and diets were not able to help her shed off the extra pounds and if she managed to shed any weight, it always had an uncanny habit of finding her. May be hypothyroidism was to blame. Post pregnancy she piled on some more kilos. “After all, how long can you refrain from eating”, says she, it was just not practical. Needless, to say, she was hunting for a solution that would help her come out of this obesity trap and on the advice of a close friend she thought of giving bariatric surgery, a shot, and has been successful for the first time in her life to lose weight and also to keep those lost kilos away from finding her.

Bariatric surgery– the latest and the last word in the weight loss is creating a lot of buzz these days. What is it and who is the right candidate for it? Irrespective of the talk, the surgery involves your insides, your stomach to be precise, and it is natural to be skeptical on the subject. Dr. Pradeep Chowbey, Chairman – Minimal access and bariatric surgery centre, Sir Ganga Ram Hospital, New Delhi clarifies, “We do 250 bariatric surgeries in a year” Dr. Sandeep Malhotra, bariatric surgeon at Artemis adds, “Around 5 to 6 of bariatric surgeries take place in a month’s time.”

Bariatric surgery is the last resort to lose weight for morbidly obese people and to reclaim life. If the term morbid obesity flummoxes you, it is a condition where your own weight becomes the biggest threat to your health. Dr. Chowbey explains, “The surgery alters the digestive system by decreasing size of stomach, so fat appetite decreases. In addition, the path of food through intestine may be altered so absorption is less. There are types of bariatric procedures available, which may be effectively applied depending on the patient type.”

The suitable candidate

Bariatric surgery is not the answer, if you are looking for contouring or sculpting your body—like liposuction. The latter is a cosmetic procedure that involves spot reduction and if you do not adhere to lifestyle changes the sucked-out fat finds you back. Whereas, bariatric surgery, is a life-saving surgery that addresses graver health concerns (research studies say it can reverse diabetes) and is recommended to people for whom losing weight is an imminent concern, and who have exhausted known routes of weight loss—diet and exercise. Agreed, diet and exercise is the practical approach to shed kilos, but this approach has its limits. “Weight loss cannot be sustained long term, and the weight tends to bounce back. Also, the loss is less than 10% of excess body weight at best”, says Dr. Malhotra.

Unless you suffer from morbid obesity, surgery is not for you. Morbid obesity is a condition where the persons weigh approximately 35-40 kilos more than their ideal body weight. Naturally, this kind of weight makes exercising difficult, as joint health gets affected. The excess weight jeopardizes the health of morbidly obese people, making them easy targets for diabetes, which in turn increases their risk factors for cardio-vascular diseases. In women menstrual irregularities too happen. Thwarted attempts at weight loss frustrate their confidence leading to psychological problems.

The BMI factor–Putting first things first, find out your BMI, which expresses the ratio between a person’s body weight and their height (kg/m2).

Obese people are those who have a Body Mass Index (BMI) of 30 or greater and morbidly obese people are those who have a Body Mass Index (BMI) of 40 or greater (Roughly equivalent to 45 kg over your ideal body weight).

Dr. Kapil Kochhar, laproscopic surgeon, Moolchand Medcity says, “Surgical treatment is the only proven method of achieving long-term weight control for the morbidly obese, when all other therapies have failed.”

The process

Since the process involves your stomach, it has to be meticulous. The bariatric surgeon– a highly skilled and experienced laparascopic surgeon, who must have done hundreds of advanced laparascopic surgery before he starts bariatric surgery, dietician, physiotherapist and psychologist evaluates the person. An endocrinologist is also part of the team, as most of these patients have co-existent diabetes, thyroid problems and so is a cardiologist to evaluate heart, lung and general condition. “If a patient is a suitable candidate, s/he is placed on a high protein and low carbohydrate diet for two weeks prior to surgery”, says Dr. Malhotra.

Weight Loss Surgery Procedures
There are two basic mechanisms of weight loss surgery. Restrictive procedures decrease food intake by creating a small upper stomach pouch to limit food intake. Malabsorptive procedures alter digestion, thus causing the food to be poorly digested and incompletely absorbed. There are several procedures that combine the restrictive and malabsorptive mechanisms of weight loss surgery.

Risks associated

All major surgery involves a certain level of risk, including death. Risks involved with weight loss surgery vary according to the procedure performed.
 Patients of morbid obesity are at increased surgical and anesthesia risk due to their excessive weight, which is an additional strain on their heart and lungs.

 The risk of bariatric surgery is similar to most surgeries performed on the digestive system. These include risk of bleeding or leak from a joint in the intestine. However, the incidence of these risks is about one percent or so, which can be managed by various methods.

 General risks include bleeding, infection, blood clots in the legs and pneumonia. In case of Laparoscopic band, a slip or erosion could occur in up to 2% cases.

 In sleeve Gastrectomy and gastric bypass, leak at staple line or narrowing can occur. Over all risk is 0.1% for banding, 0.3% for sleeve Gastrectomy and 0.5% in gastric bypass.

Coming back to Gitanjali, she is a happy woman today. She has lost weight and gained confidence, energy and health. She confesses, “Once I am through with my meals I have conquered temptations, and I cannot eat much either”. Her doctor has advised her to keep an arm’s length from liquid calories, read sodas and juices, but this does not bother her, she was never a big fan of it.

Points to remember

1. Surgery involves lifestyle modifications– small diet, less water with food, proper chewing of food, marked reduction in high calorie shakes or carbonated drinks.
2. You need to take a multi-vitamin and mineral supplement all your life.
3. You do not become obese in one day. If you start shying away from weighing scales, this means you are piling up kilos, and you need to work aggressively towards losing weight.
4. Finally, there are no shortcuts in life, even after surgery, you can’t do away with exercise.

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