Bariatric & Metabolic Surgery Specialist

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.

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 than that a normal-weight person.

That is the reason why surgery for obesity has great relevance in treating excess weight and curing/improving most of these medical conditions along with the surgery.

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 an overall reduction in body weight and helps to improve associated medical disorders of excess body weight. 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.

The short answer is no. Surgery is not a solution for everyone. We only determine whether a patient is right for surgery after a complete evaluation and discussion with the patient. Because weight loss surgery is a life-altering procedure, we want to make sure our patients are committed to making the lifestyle changes needed for a successful procedure.

You are what you eat. You may be eating less but you may not eating right. One may be consuming high calorie foods although in small amount that you are still gaining weight despite not eating much.

Awareness about the type of food you should eat can help you in planning a wholesome diet that is adequate in an amount that won’t allow you to feel hungry and still you would lose weight. Dieting does not mean eating less but it should be eating right and it is a lifelong commitment. Short-term dieting results in failure and loss of morale.

As a general goal, aim for at least 30 minutes of physical activity every day. Moderate aerobic exercise includes such activities as brisk walking or swimming. Vigorous aerobic exercise includes such activities as running and aerobic exercises.

Because 3,500 calories equals about 0.45 kilogram of fat, you need to burn 3,500 calories more than you take in to lose .045 Kg. So one need to plan out caloric intake and do regular exercises to have good weight loss. Here is a chart to have an idea about how much weight loss you can achieve with diet and exercises.

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)

These procedures help in reducing 50-85% excess body weight. The amount of weight you lose — and how fast you lose it — depends on which weight loss surgery you have. 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 improves and a vast majority of them become completely normal blood sugar levels normal after surgery. Hypertension & high cholesterol improves significantly. These effects along with a good amount of weight loss reduce the risk for heart disease significantly.

There is a good relief for sleep problems, apnoea, and acid reflux symptoms. As the body weight comes down body pain and joint arthritis improve 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.

All these procedures are done by laparoscopic Surgery.

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 65-75% of excess weight loss.
2. Mini Gaastri bypass – in this procedure stomach is converted from pouch like shape to tube like structure and small intestine is joined to it so that food bypass large amount of small intestine where food is absorbed thus resulting in lesser absorption of food. This procedure result in around 70- 85% of excess weight loss.
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 70-85% of excess weight-loss.
4. Sleeve gastrectomy with duodenojejunal bypass – Here stomach is converted from pouch like shape to tube like structure and distal small intestine is anastomosed to duodenum thus bypassing large amount of absorptive area of small intestine. This procedure although slightly complex but has lesser side effect.

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.

After having any form of bariatric surgery your body will undergo a dramatic transformation as a large amount of weight is lost. This weight loss is obviously the desired outcome with any weight loss surgery but a side effect of a large rapid weight loss is the potential to have large amounts of excess skin.

Skin does have some elasticity to it and will recoil or bounce back when weight is lost. However, when a large amount of weight is lost in a short period it is much more difficult for all the skin to bounce back so that there is no excess. This is when the patient must consider the option of plastic surgery to remove this excess skin.

Women should avoid pregnancy for at least 18 months after surgery. Please discuss any pregnancy plans with your surgeon during one of your clinic appointments.

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.

There is no serious or major side effect after bariatric surgery. Patient has only to gain after bariatric surgery. Few patients may experience hair loss, bony pain, weakness, heart burn etc but these can also be avoided if patient takes his supplements religiously.