Bariatric Surgery

Centre of excellence

Bariatric Surgery

Bariatric surgical procedures cause 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 cause hormonal changes. Most weight loss surgeries today are performed using minimally invasive techniques (laparoscopic surgery).

The most common bariatric surgery procedures are gastric bypass, sleeve gastrectomy, adjustable gastric band, and biliopancreatic diversion with duodenal switch. Each surgery has its own advantages and disadvantages.

It is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health,leading to reduced life expectancy and/or increased health problems. A person is considered obese when their body mass index (BMI), a measurement obtained by dividing a person's weight in kilograms by the square of the person's height in meters, exceeds 30kg/m2.

  • Genetic predisposition
  • Excessive calorie intake
  • Inadequate energy expenditure(physical work)
  • Hormonal disorders, e.g.,hypothyroidism,Cushing's syndrome

It is measured by calculating the BMI (BMI = Weight in kg / Height in meter2)

Body weight can be graded in the following categories according to the BMI.

Weight Categories BMI (kg/m2)

  • Underweight <18.5
  • Healthy weight 18.5-24.9
  • Over weight 25-29.9
  • Obese 30-34.9
  • Severely Obese 35-39.9
  • Morbidly Obese >40

Obesity does bring several life threatening medical diseases along with it. It is much more than a cosmetic predicament. A 25 year old morbidly obese man has a 22% reduction in expected remaining lifespan. This is approximate loss of 12 YEARS! The most common medical conditions because of obesity are diabetes, high BP and increased blood cholesterol, which can lead to heart attack, stroke (brain attack) and many more health related issues.

The ABC of weight loss is D and E - Diet and Exercise, with a predominant role played by Diet.

Metabolic rate is different in every person. People with lower metabolic rate, tend to develop obesity. Only dieting cannot achieve substantial weight loss. Once you go on a low calorie diet, initially you lose weight after which a plateau is reached. Further weight loss is either slow or no more. Frustration sets in, followed by discontinuation of the diet.

Yes, there are. However , these have been shown to be ineffective and associated with side effects. There is no magic pill for the treatment of obesity.

It a type of surgery that is performed to induce long term weight loss and to facilitate cure of the associated medical conditions, e.g., diabetes, hypertension. Bariatric surgery is often confused with liposuction. Liposuction is a cosmetic surgery and does not help morbidly obese patients in reducing their weight or curing associated medical ailments. Bariatric surgery is not a cosmetic surgery. It is a medically prescribed procedure for the treatment of morbidly obese patients.

If you are morbidly obese (BMI > 40 or BMI > 35 with co-morbidities, BMI > 37.5 or BMI 32.5 with co-morbidities for Asia Pacific); and you have failed to lose weight significantly by other methods, and if you are committed and motivated for a lifelong change in the life style, then you qualify for bariatric surgery. It is also important to make sure that you do not have any endocrine and metabolic disorders causing obesity.

Advances in laparoscopic surgery have facilitated these immensely beneficial procedures to be done with lesser pain, faster recovery and fewer wound related issues. The most commonly performed procedures are described below.

Commonly performed procedures Laparoscopic Sleeve gastrectomy,Laparoscopic Roux-en-Y gastric bypass,Mini gastric bypass

Weight loss is not immediate. Different procedures result in different weight loss outcomes. However, on an average, patients may lose 30-50% of their excess weight in the first 6 months and nearly 77% in the first year. This is highly dependent upon the patient's commitment to and the compliance with post-surgical diet and exercise regimen.

The risks of remaining obese will eventually outweigh the risks associated with the surgery. When performed in an appropriate patient by an expert, the risks can be minimized. The risks include bleeding, anastomotic leak (loosening of the staple lines), blood clots in the legs, pulmonary embolism, vomiting due to decreased size of the stomach, vitamin and micronutrient deficiencies.

After a laparoscopic bariatric surgery, most of the patients stay for 2-3 days after surgery. You can return to work in 7-10days after surgery.

There are certain life style changes necessary in order to succeed in this big step along your weight loss journey. Your diet and exercise routine will be the two most important components of this journey,especially in the first year after surgery. Post-operative follow-up care and support group meetings are the additional key components after the surgery.

Individuals who are committed to their post-operative care and follow the advice of their clinician are more likely to be successful in maintaining their weight loss.

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