Dr Om Tantia, Medical Director & Head -Dept of MAS and Bariatric Surgery, ILS Hospitals, gives an overview about bariatric surgery and its advantages
What is bariatric surgery?
The word bariatric is derived from the Greek word ‘baros’, which means heavy and ‘iotrics’ which means medical treatment. Bariatric surgery is the most effective measure to treat chronic obesity and related diseases with sustained results.
Severe obesity, sometimes known as ‘morbid obesity,’ is defined as being more than 100 pounds overweight or twice your ideal body weight. Severe obesity is a well-established risk factor for development of coronary artery disease, type II diabetes, dyslipidemia, hypertension and certain cancers. The risk of developing these additional medical problems is proportional to the degree of obesity.
Remedial approaches: Numerous medical approaches to this problem have been advocated, including low-calorie diets, drugs, behavioral modification and exercise therapy. Unfortunately, many patients are unable to maintain reduced body weight. Surgical intervention is a treatment proven to be effective in the long-term management of morbid obesity.
Obese individuals are at far greater risk of dying from obesity-related diseases, including coronary artery disease, hypertension (high blood pressure), type II diabetes and certain cancers. Individuals who are obese have a 10 per cent to 50 per cent increased risk of death from all causes. A healthy weight for most people is defined as a body mass index (BMI) between 18.5 and 24.9. Severely obese people live less. According to some study every 10 kgs extra on a person’s body reduce their life span by three years.
Who are eligible and what results can one expect from laparoscopic bariatric surgery?
Eligibility for a laparoscopic procedure is based on the severity of the BMI, presence and absence of associated diseases like diabetes mellitus (DM), hypertension etc. The type of surgery is to be tailor-made as per the patient’s condition. Sleeve gastrectomy and mini gastric bypass are widely practiced procedures with good success.
Bariatric surgery will induce a good amount of weight loss along with great improvement, resolution of diseases like HTN, DM etc. The excess weight loss can vary from 40 per cent to 80 per cent depending upon the type of procedure and patients compliance.
BMI calculation
BMI = Weight (kg) / Height 2 (m)
Standard measurement for BMI (Asian Figures)
Normal Weight 18.5 – 22.5
Overweight 22.5 – 27.5
Class I Obesity 27.5 – 32.5
Class II Obesity 32.5 – 37.5
Class III Obesity Above 37.5
Super Obese > 50
How is bariatric surgery performed?
Sleeve gastrectomy: The stomach is stapled to reduce the capacity and this causes hormonal changes too so that weight loss and control of diabetes is achieved.
Mini gastric bypass (MGB): The stomach is converted into a long tubular pouch and is connected with a loop of small intestine, which channels the food directly into the small intestine and brings about control of obesity and diabetes.
Roux-en Y gastric bypass: Principles of surgery are same as MGB but with some variation in surgical procedure like loop is connected to stomach after the division.
Who can be operated for bariatric surgery?
- < Someone with BMI over 35, with or without co-morbidities
- < Someone with BMI over 30 and one or two significant co-morbidities like type – II diabetes, hypertension and sleep apnea.
- < Someone with BMI over 30 or 35 and having a history of failed attempts with diet plans, behavioral and medical therapies.
What post–operative care should one should take after surgery?
Patients can resume their normal duties after a week of surgery. The diet is gradually increased in consistency from liquid to solid in a phased manner and the patients can have his normal choice of food after few days.
Patients are encouraged to undertake morning walks and free hand exercises as soon as possible. Normally patients are put on a capsule of Vit-B complex as a supplement. They should avoid over eating, soft calories, fizzy drinks, alcohol and smoking.
Overview of the benefits of the surgery
- < Increased life expectancy
- < Resolution or improvement of obesity-related health conditions
- < Long-term weight loss (sustained weight loss)
- < Improvement of mood and quality of life
- < Overall improvement in social and emotional well-being.