Surgery for Obesity
 
Bariatric Surgery or Surgery for morbid Obesity
What patients/candidates should know
 
What is Obesity? What are the health hazards because of obesity?

Obesity means having excess body fat in relation to ones height and weight. Obesity generally is determined by calculating body mass index (BMI), which is calculated by the weight in kilograms divided by height in meters squared.
 
  BMI
18.5 – 24.9
25 – 29.9
30 – 34.9
35 – 39.9
> 40
> 50		 Status 1
Normal
Overweight
Obese
Severe Obesity
Morbid Obesity
Super morbid Obesity
 
* Among Asian Indians, the recommended BMI for obesity surgery is >32.5 with co=morbid illnesses and >37.5 in Obese individuals. (Consensus Statement for diagnosis and treatment of Obesity, JAPI, Vol.57, February 2009. www.japi.org)
 
1. National Institutes of Health and National Heart, Lung, and Blood Institute. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report. Obes Res 1998;6(suppl 2):1S-209S.

Severe obesity damages the body by its mechanical, metabolic and physiological adverse effects on normal bodily function. These "co-morbidities" affect nearly every organ in the body in some way, and produce serious secondary illnesses, which may also be life-threatening. The following are the excess risk of associated illnesses related to obesity.
 
      Co-Morbidity     Percentage of more risk 
      Diabetes     20-40%   
      Hypertension      25-55% 
      Hyperlipidemia      35-53% 
      Cardiac disease       15-25% 
      Respiratory disease      10-20% 
      sleep apnea      20-30% 
      Arthritis       20-30% 
      Depression      70-90% 
      Stress Incontinence      40-50% 
      Menstrual irregularity          15-25% 
With BMI > 30 there is 55% increase in mortality, 70% increase in coronary artery disease, 75% increase in stroke and 40% increase in diabetes. So, morbidly obese males between 25 and 35 have 12x the chance of dying as normal weight men. A morbidly obese adult has a 33% less chance of living to age 65 as that of a normal weight person. That is the reason why surgery for obesity has great relevance in treating the excess weight and cures/ improves most of these medical conditions along with the surgery.
 
What is Bariatric surgery? How is it different from liposuction?

Bariatric surgery involves surgical methods to restrict or to reduce absorption of food from stomach and intestine. This is not a cosmetic surgery. This procedure results in overall reduction in bodyweight and helps to improve associated medical disorders of excess bodyweight. Liposuction is a cosmetic surgery wherein part of body fat is removed using high power suction, which usually does not produce any sustained weight loss.

Who should undergo this procedure?

As a first line of treatment diet and exercises should be tried. Patients who had a trial of diet, regular exercise and probably drugs and failed to have a sustained weight loss must think about this surgery. Among Asian Indians, the recommended BMI for obesity surgery is >32.5 with co=morbid illnesses and >37.5 in Obese individuals. (Consensus Statement for diagnosis and treatment of Obesity, JAPI, Vol.57, February 2009. www.japi.org)

How effective is weight-loss surgery? What are the benefits and is the effect long term?

These procedures help in reducing 50-85% excess body weight. The amount of weight loss varies depending on the type of procedure chosen (usually done by the doctor). Along with weight loss most of the medical co-morbidities improve which in turn improves patients self esteem and confidence. Some of the important benefits are

• Diabetes mellitus Type II in these patients improve and a vast majority of them become completely normal blood sugar levels normal after surgery.

• Hypertension & high cholesterol improves significantly. These effects along with good amount of weight loss reduce risk for heart disease significantly.

• There is good relief for sleep problems, apnoea and acid reflux symptoms.

• As the body weight comes down body pain and joint arthritis improves very well.

• Overall improvement in the sense of well being and self esteem.

The effect of these procedures is long term in terms of weight loss and improvement of co-morbidities, if the patient adheres to the follow up advice of the doctor.
 
What are the different Types of Bariatric Surgery Procedures?

 All these procedures are done laparoscopically.

1. Sleeve Gastrectomy: In this procedure stomach is converted to a long tube-like structure to reduce its capacity. This is less complex operation and produces about 60-68% weight loss.

2. Adjustable Gastric Banding: In this procedure a ring like band is band is placed around stomach to convert initial part of stomach to a small pouch. No part of stomach is removed in this procedure and probably that is the disadvantage of this procedure as it produces about 50-55% of excess body weight-loss only.

3. Roux-en-Gastric Bypass (RYGB) procedure: Here the stomach is stapled to convert it to a small pouch and this helps in restricting food intake. Further a segment of intestine is bypassed from the food stream so that nutrients are exposed to less absorptive surface of small intestine. So this is a restrictive and malabsorptive procedure, which results in 65-75% of excess weight-loss.
 
How safe is bariatric surgery?
This surgery is very well established now and thousands of these procedures are being done worldwide. In expert hand and in centres with good facilities the mortality risk of these procedures is estimated as 0.3 per 100 procedures.
 
What about medicines and follow up?

After surgery one need to have multivitamins, calcium tablets etc. if necessary as per the situation. You may need to observe some diet restrictions too for long term effects of the procedure, and in the initial few months you require follow up.
 
 
Home About Me GI Surgery & Laparoscopic Surgery for Obesity Gallery Contact Me   Powered by euroinfotech.net