World Obesity Day: All you need to know about Bariatric Surgery

Bariatric Surgery, its procedure and benefits

• Obesity is a chronic progressive disease not only affecting an individual’s physical aspects, but also his family and his productivity. Incidence of overweight and morbid obesity is rising worldwide and in India, it is no different, 25% of individuals are overweight and 7-10% are suffering from metabolic syndrome or morbid obesity.

• In this article, Dr Manoj Jain, Consultant, Bariatric Surgery at Kokilaben Hospital, explains how bariatric surgery can help people with obesity, the procedure, and its benefits.

• A sedentary lifestyle is a major cause of obesity. During the lockdown because of the pandemic, people largely restricted their activities and weight gain has become a major issue. This global health problem is now considered a disease by WHO as it contributes to the development of many life-threatening conditions, which is why it is essential to treat obesity.

• Body Mass Index (BMI) is a ratio of weight in kg and height in meter square used to measure the degree of obesity. As BMI increases, there is an increased risk of developing health problems. The most common problem associated with obesity is Type II Diabetes Mellitus with about 40% of obese patient developing diabetes. Other health problems include hypertension, hyperlipidemia (a condition when there are high levels of fat particles in the blood), sleep disturbance, joint problems, infertility, heart disease, and DVT (Deep Vein Thrombosis- formation of a blood clot in deep veins). Early treatment of obesity will prevent the development of these health problems.

• The first approach to manage obesity is usually a balance of diet and exercise over an extended period. However, some people find it difficult to lose weight in spite of trying various diet and exercise regimens. This is especially in cases of second and third-degree obesity with BMI (Body Mass Index) of 32.5 and above, especially accompanied by health problems like diabetes and heart disease. It is in these cases that Bariatric Surgery can help.

• Bariatric surgery works on the concept of causing weight loss by restricting the amount of food the stomach can hold, causing malabsorption of nutrients, or by a combination of both gastric restriction and malabsorption. Bariatric procedures also often lead to hormonal changes. The surgery is performed using minimally invasive techniques like laparoscopic surgery. In the last few years, bariatric surgery has transformed into a relatively standard, safe and effective procedure.  In bariatric surgeries, part of the stomach is removed or reduced in size and in some cases, part of the intestinal length is also reduced. There is gradual weight loss after surgery – 70 to 80% of excess weight loss is achieved at the end of 1½ years post-surgery. Weight loss is more in the first 6 months.

• There are mainly 4 kinds of procedures. The simplest is a gastric balloon in which the stomach is filled with balloon endoscopically and it gives a sense of fullness and satiety. While it is reversible, but it is not very effective as balloon have to be removed after 6 months. It also does not cause a reduction in the secretion of the hunger hormone “ghrelin” by the cells in the G.I. tract.

• The other three procedures are sleeve gastrectomy, gastric bypass and mini-gastric bypass. These involve

• considerable changes to the stomach and intestines, and in 86% of the cases, result in sustained weight loss, usually 70 to 80 per cent patient’s excess weight.

• Bariatric surgery results in greater weight loss than non-surgical weight loss interventions and is highly effective in treating obesity-related comorbidities. People of all ages can benefit from bariatric surgery as the quality of life is significantly improved after undergoing this surgery. Thus severe obesity is best treated with bariatric surgery.