Bariatric surgery

What is Bariatric surgery?

Bariatric surgery is a procedure performed on individuals who are severely overweight or obese to help them lose weight and improve their overall health. It is considered when other weight loss methods, such as diet and exercise, have been unsuccessful in achieving significant and sustained weight loss. The primary goal of bariatric surgery is to reduce the size of the stomach, which limits the quantity of food the person can consume. By doing so, the surgery helps in decreasing the absorption of nutrients and calories, leading to weight loss. There are different types of bariatric surgeries, but the most common ones include:

• Gastric Bypass: In this procedure, the surgeon creates a small pouch of the stomach, which is then connected directly to the small intestine, bypassing a large part of the stomach and the upper portion of the small intestine.

• Sleeve Gastrectomy: This involves removing a portion of the stomach, leaving a banana-shaped sleeve-like structure. The stomach's reduced size limits the quantity of food that can be consumed.

• Adjustable Gastric Banding (Lap-Band): The surgeon places an inflatable band around the upper part of the stomach, creating a smaller pouch. The band can be adjusted to control the size of the passage between the smaller and larger portions of the stomach.

• Biliopancreatic Diversion with Duodenal Switch (BPD/DS): This is a more complex procedure that involves partial removal of stomach to create a smaller stomach, similar to the sleeve gastrectomy. Additionally, it redirects bile and pancreatic juices to the lower portion of the small intestine to limit nutrient absorption.

Bariatric surgery is a major procedure and is typically recommended for individuals with a body mass index (BMI) above 40, or above 35 if they have obesity-related health conditions such as type 2 diabetes, hypertension etc.

Why and when is Bariatric surgery recommended?

Bariatric surgery is recommended for individuals who are severely overweight or obese and have not achieved significant and sustained weight loss through other methods, such as diet, exercise, and lifestyle changes. It is typically considered when obesity poses serious health risks and impacts a person's quality of life.

The main reasons for recommending bariatric surgery include:

• Obesity-related health conditions: Bariatric surgery is often recommended for individuals who have obesity-related medical conditions, such as type 2 diabetes, hypertension (high blood pressure), sleep apnea, heart disease, and joint problems. Significant weight loss resulting from surgery can lead to the improvement or resolution of these conditions.

• High body mass index (BMI): Bariatric surgery is generally considered for individuals with a BMI of 40 or higher, which is classified as "severe" or "morbid" obesity. It may also be recommended for individuals with a BMI of 35 or higher if they have obesity-related health conditions.

• Inability to lose weight through other means: Bariatric surgery is an option for those who have tried and failed to lose weight through dieting, exercise, and behavior modification programs.

• Improvement of overall health: Bariatric surgery not only aids in weight loss but can also improve overall health, leading to a reduction in the risk of various obesity-related diseases and conditions.

How is Bariatric surgery different from the conventional treatment?

Bariatric surgery is a surgical procedure designed to aid in weight loss and treat obesity, while conventional treatment refers to non-surgical approaches for weight management. Here are the key differences between bariatric surgery and conventional treatment for obesity:

1. Nature of Treatment:

• Bariatric Surgery: Bariatric surgery is a surgical intervention that alters the digestive system to restrict food intake or reduce nutrient absorption. It involves anatomical changes to the stomach and sometimes the small intestine to induce weight loss.

• Conventional Treatment: Conventional treatment for obesity includes non-surgical approaches such as lifestyle modifications, dietary changes, physical activity, behavioral therapy, and medications for weight management.

2. Level of Weight Loss:

• Bariatric Surgery: Bariatric surgery can lead to significant and sustained weight loss. Patients may lose a substantial amount of weight in the months following the procedure.

• Conventional Treatment: Conventional treatment may result in moderate weight loss over time. It often requires long-term commitment and lifestyle changes to achieve and maintain weight loss. The major drawback of conventional treatment is the inability to achieve ‘sustained’ weight loss and the frequent weight regain on cessation of treatment.

3. Speed of Weight Loss:

• Bariatric Surgery: Weight loss after bariatric surgery is relatively rapid, and patients may notice significant improvements in their health and quality of life within the first year.

• Conventional Treatment: Weight loss through conventional treatment tends to be gradual and may take several months to see noticeable changes.

4. Impact on Co-existing Health Conditions:

• Bariatric Surgery: Bariatric surgery has been shown to improve or resolve many obesity-related health conditions, such as type 2 diabetes, high blood pressure, sleep apnea, and joint pain, among others.

• Conventional Treatment: Conventional treatment can also improve some health conditions associated with obesity but may not provide the same level of resolution as bariatric surgery.

5. Eligibility Criteria:

• Bariatric Surgery: Bariatric surgery is generally recommended for individuals with severe obesity (BMI 40 or higher) or those with a BMI of 35 or higher with significant obesity-related health conditions.

• Conventional Treatment: Conventional treatment is suitable for individuals with overweight or mild to moderate obesity and can be tailored to their specific needs and health conditions.

6. Risks and Complications:

• Bariatric Surgery: Bariatric surgery is generally a safe surgical procedure but carries potential risks and complications, including infection, bleeding, and nutritional deficiencies. The complication rate of the procedure is very low in experienced centres.

• Conventional Treatment: Conventional treatment typically involves lower risks since it does not involve surgical interventions.

7. Long-Term Outcomes:

• Bariatric Surgery: Bariatric surgery can provide long-term weight loss and health improvements, but patients must commit to lifelong changes in eating habits and lifestyle.

• Conventional Treatment: Long-term weight loss through conventional treatment depends on individual adherence to lifestyle changes and varies among individuals.

How is life after Bariatric surgery?

Life after bariatric surgery can be a transformative experience for individuals who have struggled with obesity. Bariatric surgery is a significant step towards weight loss and improved health, but it also requires lifelong commitment and lifestyle changes to ensure long-term success. Here's what you can expect and some key aspects of life after bariatric surgery:

• Weight Loss and Health Improvements: After bariatric surgery, patients typically experience significant weight loss over time. The amount of weight loss varies among individuals and depends on the type of surgery and adherence to post-operative guidelines. As the weight decreases, many obesity-related health conditions may improve or even resolve, such as type 2 diabetes, high blood pressure, sleep apnea, and joint pain.

• Dietary Changes: Life after bariatric surgery involves a complete overhaul of dietary habits. Patients are typically put on a restrictive diet initially, gradually transitioning to a more balanced and nutrient-dense eating plan. Portion control and mindful eating become crucial for long-term success.

• Physical Activity: Regular physical activity is an essential part of life after bariatric surgery. Exercise not only aids in weight maintenance but also improves overall health, energy levels, and mood. Finding enjoyable forms of physical activity can help individuals stay motivated.

• Follow-Up and Support: After bariatric surgery, patients undergo regular follow-up appointments with their healthcare team to monitor progress and address any concerns. Many bariatric surgery programs also provide ongoing support, including access to support groups and counselling.

• Emotional Well-Being: Emotional well-being is a vital aspect of life after bariatric surgery. Some individuals may experience emotional changes or face challenges related to body image and adjusting to the new lifestyle. Counselling and support groups can be beneficial in addressing these emotional aspects.

• Lifelong Commitment: Bariatric surgery is not a quick fix but a tool that requires lifelong commitment to dietary and lifestyle changes. Patients need to continue following their post-operative guidelines and attend regular check-ups to ensure long-term success and health benefits.

• Potential Complications: While bariatric surgery can lead to significant health improvements, it is not without risks. Potential complications can arise after surgery, and patients should be vigilant about monitoring any unusual symptoms and seeking medical attention when needed.

• Relationship with Food: Life after bariatric surgery involves developing a healthier relationship with food. Patients learn to focus on nourishment and satisfaction from eating, rather than using food as an emotional coping mechanism.

• Increased Energy and Activity: As weight decreases and overall health improves, many individuals experience increased energy levels and a greater ability to engage in physical activities they may not have been able to do before surgery.

• Social Implications: Life after bariatric surgery may involve navigating social situations and explaining dietary restrictions to friends and family. Open communication and understanding from loved ones can be helpful during this adjustment period.