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The study of bariatrics is a highly advanced and sophisticated discipline of medicine dealing with a wide range of surgical procedures, aimed at losing weight by making necessary changes in the human digestive system.
These complex surgeries handled by bariatric surgeons are usually divided into restrictive, malabsorptive and hybrid (a combination of restrictive and malabsorptive). Though the classifications were done long ago, these standard care procedures are precisely followed for achieving the desired results. While all the bariatric procedures primarily cause hormonal effect and aid in losing weight, certain procedures for the remission of diabetes is recommended only for those patients with a BMI that falls in the class 1 obesity range.
- Lap Adjustable Gastric Banding (Restrictive)
Lap Adjustable Gastric Banding is a popular and widely performed bariatric surgical procedure under which an adjustable band is placed around the upper most part of the stomach separating the stomach into a small and large portion. Intended at decreasing the consumption of food, this silicone band usually known as lap-band, A band or LAGB slows down the amount of food consumed in the single go, providing a sense of satiety. The patient who had undergone Lap Adjustable Gastric Banding would be able to considerably reduce the amount of food and fluid intake and avoid sudden hunger pangs, thus leading to weight loss.
Advantages:
It is a reversible procedure
The patient will feel better digestion of food and it won’t obstruct the absorption of nutrients
- Sleeve Gastrectomy (Restrictive)
Widely known as Vertical Sleeve Gastrectomy, Sleeve Gastrectomy is an invasive weight-loss procedure in which the stomach is reduced to about 25% of its original size by removing a large portion of the it, along the greater curvature. During the procedure the expert surgeon would also remove the ghrelin hormone secreting fundus, responsible for appetite, thus suppressing hunger as well. Typically done as a laparoscopic procedure, the patient would recover much faster and would witness faster results.
Advantages:
Excellent weight loss at one year
Great appetite suppression and restricts hunger pangs completely
Low risk of peptic ulcer
No vitamin or drug malabsorption
- Banded Sleeve Gastrectomy (Restrictive)
Under Banded Sleeve Gastrectomy, a loose band is placed over the completed sleeve gastrectomy tube to prevent sleeve dilation and to improve food restriction. It ensures that the restrictive effect of sleeve is maintained in the longer run and avoid weight gain.
Advantages:
Prevents weight regain
Sustainable weight loss and visible results
- Roux-En-Y Gastric Bypass (Combined – Restrictive/Malabsorptive)
Roux-En-Y Gastric Bypass is a laparoscopic bariatric procedure in which a small pouch of stomach is created by stapling off the upper portion of the stomach. After that the expert surgeon would attach the pouch directly to a part of small intestine called as Roux limb forming it into a ‘Y’ shape. The idea behind this procedure is to bypass the rest of the stomach and also upper portion of small intestine to limit the absorption of fat and calories in the foods consumed, thus leading to weight loss.
Advantages:
About 95 % of co-existing health problems including type 2 diabetes, high BP, high cholesterol, sleep apnoea, depression, back pain was improved or resolved. Also, the risk of developing heart attack and stroke is significantly lowered.
Highly sustainable weight loss.
Maintenance of weight in the longer run is easier
- Banded Gastric Bypass (combined – Restrictive/Malabsorptive)
Banded Gastric Bypass is a combination of both restriction and malabsorption in which a loose band is applied over the completed pouch in Gastric Bypass. The restrictive procedure triggers weight loss while the malabsorption bypasses the part of small intestine by diverting biliopancreatic secretions limiting the absorption of fat and calories. This procedure also prevents pouch dilatation that can happen later thus preventing weight regain.
Advantages:
This procedure is similar to standard gastric bypass.
Weight regain can be avoided
- Mini gastric Bypass/ One Anastomosis Gastric Bypass (Combined – Restrictive/Malabsorptive)
Mini Gastric Bypass is a technical modification of the standard gastric bypass with the same results. The surgery is simpler compared to the Roux-en-y Gastric Bypass and hence less time consuming.
Advantages :
Triggers weight loss
Reversible procedure
- Bilio Pancreatic Diversion With Duodenal Switch (Malabsorptive)
Bilio Pancreatic Diversion With Duodenal Switch is done in two steps, but in a single procedure. In the first stage, a sleeve gastrectomy is performed and 80 per cent of the stomach is removed. And in the second step, the remaining stomach that looks like a small tube bypasses the upper part of the small intestine and the end portion of small intestine then gets connected to the duodenum near the stomach.
Advantages:
Provides positive results and faster weight loss
Best outcome for patients suffering from Type 2 Diabetes Mellitus and high levels of cholesterol.
Surgeries For Diabetics:
Diabetics is a chronic disorder affecting millions of people across the globe annually. The high levels of blood sugars, if not controlled can cause major health complications including heart attack, cardiovascular diseases and can compromise the function of other vital organs. The bariatric procedures are a boon to those diabetics also combating obesity. Several studies reveal that weight loss after these procedures resulted in remission of this metabolic and lifestyle disorder for up to 10 years.
- Short duodenal switch / Loop duodenal switch (combined – Restrictive/Malabsorptive)
Short duodenal switch / Loop duodenal switch is a technical modification of the standard BPD wherein the malabsorptive component is less, thus resulting in regulated blood sugars. There is a single anastomosis making the surgery less time consuming.
Advantages :
Excellent resolution of type 2 Diabetes.
Good weight loss in obese patients
- Ileal interposition
Ileal Interposition is not just a bariatric procedure but is also widely recommended for those suffering from type-2 diabetes. Under this procedure, a long segment of the last potion of small intestine (ileum) is cut and joined very close to the stomach. Undigested food now first enters ileum to stimulate gut hormones called GLP-1 which acts along with insulin to reduce blood sugar.
Advantages:
Can also be performed on non-obese diabetic patient
Endoscopic Procedures:
Endoscopic procedures are an in-thing in the field of bariatrics and metabolic surgeries. The procedures which are very precise are less time consuming and the patient gets discharged the same day.
- Intra Gastric Balloon
Intra Gastric Balloon is done by placing an adjustable balloon through an endoscope and inflated with saline inside the stomach. It is left in the stomach for 6 months to 1 year till weight loss happens. The balloon provides the feeling of satiety and controls the hunger pangs.
Advantages :
Day care procedure – Can be discharged same day
Non-Surgical procedure
- Endoscopic Sleeve Gastroplasty
Using an endoscope, the size of the stomach is reduced. This relatively newer procedure is gaining popularity owing to its both short-term and long-term benefits.
Advantages :
Nonsurgical Procedure
Triggers weight loss
Why Do We Become Obese?
There are many factors that can trigger weight gain and lead to obesity. It is not uncommon for us to come across family or friends, feeling disheartened over their weight gain despite restricting the dietary habits. Here are the factors that can cause obesity.
Unhealthy eating habits
Lifestyle
Lack of physical activity
Stress
Poor sleep pattern
Drugs
Hormonal imbalance
Genetic / Familial
FAQs:
If you are planning for a bariatric surgery, it’s time to learn in detail about the procedures, effects, complications if any etc. Here are most frequently asked questions and the answers.
What Are The Parameters To Know If I Am Fat/Obese?
For every individual person, the ideal body weight depends on his/ her height. To know it exactly, doctors calculate the Body Mass Index (BMI) taking their weight and height. BMI of a normal person ranges from 18.5 to 24.9 Kg/m2
Being Fatter Is Healthier. Why Do I Worry?
That is quite a myth! Being fat is not being healthier. Obesity is also considered as a malnutrition and it can lead to other complications like Type 2 diabetes, high blood pressure, high cholesterol, increased risk of heart attack and stroke, joint pains, sleep apnoea, fatty liver causing liver failure, gall stones, menstrual disturbances in women, PCOD/ infertility issues, Depression and many other problems.
Obese people are at increased risk of developing various cancers including food pipe (oesophagus), stomach, liver, pancreas, colon, rectum, kidney, ovary, breast and uterus. By reducing weight the risk is significantly reduced.
How To Check My BMI ?
BMI refers to Body Mass Index. It is derived by dividing the body weight in Kg by the height in m2.
Ex: A person with height 170 cm, weight is 120 kg
BMI = 120/ 1.7 x 1.7
= 120/ 2.89
= 41.52 kg/m2
What Is The Normal BMI Range?
World health organisation has classified BMI as follows
18.5 to 24.9 – normal weight
25 – 29.9 – overweight
30 – 34.9 – class 1 or mild obesity
35- 39.9 – class 2 or severe obesity
40 – 49.9 – morbid obesity
>50 – super obese
>70 – mega obese
Does The Same Criteria Suit Me, As Well?
If you are an Indian or from Asia Pacific region, the BMI criteria is as follows
18.5 to 22.9 – normal
23 – 27.49 – overweight
27.5 – 32.49 – class 1 or mild obesity
32.5 – 37.49 – class 2 or severe obesity
37.5 or more – morbid obesity
Why Is There A Separate Criterion For Asians?
This is because, genetically, Asians are prone to have more visceral (internal) fat compared to the Western population. The internal fat is more dangerous and leads to all the ill effects of obesity. Considering this, the criteria is modified to address the problem at the right time.
Oops!!! I Am Overweight. What Should I Do Now ?
Don’t worry! We will fix it.
Consult our weight loss specialist at the earliest. He will analyse your records and will suggest the best solution.
What Are The Management Options For Overweight/ Obesity?
Healthy diet and being physically active are the most important things to be followed. Lifestyle changes should be strictly followed. Additionally, there are few medications that might help you in shedding your extra calories. There are also endoscopic procedures and keyhole procedures that will make you lose weight in a larger extent.
So, our nutritionist will guide you for the diet protocol and our Weight loss consultant will discuss about the physical activity, medications and surgical options available.
Will These Options Work For Me?
All weight loss measures are beneficial. However, the extent depends on the amount of excess body weight. So, feel free to discuss your diet, activity and lifestyle with our experts to help you.
I Have Been A Following Strict Diet For Quite But Still Unable To Lose Weight! Why ?
Our body weight is determined by our brain called “set point theory”. Beyond a certain weight, body will resist our efforts to lose weight. The body’s metabolism will also be on a lower side. So crash diet or fasting will not be useful to reduce the required amount of weight.
What If These Options Fail?
Diet, activity, lifestyle modifications are the first line of treatment for excess weight. Additionally, some medications may be useful. However, if these fail then Bariatric surgery will give the best result.
I Prefer Medicines To Surgery ….
Medicines can reduce maximum 10% of excess body weight if taken continuously. Once stopped, the weight regain happens. So, for overweight or mild obesity it will be a good option. But for severe obesity and morbid obesity, it is not cost effective. The desired target weight can’t be achieved and also the comorbidity resolution does not happen. Thus, medicines can’t be the answer for all patients.
What Exactly Is Bariatric Surgery?
‘Baros’ in Greek means weight.
Bariatric is derived from the Greek word Baros meaning reducing weight.
It is minimally invasive, laparoscopic (key hole) procedure which increases the body metabolism by secreting gut hormones called ‘incretins’ which acts in the brain to reset the weight. This is achieved by modifying the stomach size and the food passage in the intestine.
I Have Heard Of Liposuction. Is It Same As Bariatric Surgery?
A big NO!
Liposuction is a procedure where fat beneath the skin is sucked out using a special technique. Maximum of 5 -8 kg of fat can be removed. It is purely a cosmetic procedure. There is no weight loss involved in this and there is no improvement in comorbidities.
On the other hand, Bariatric procedure is a keyhole procedure which stimulates body metabolism to lose weight. Here no fat is removed. Body inherently burns all the excess fat over a period of few months.
How Do I Know if I am Fit For Bariatric Surgery?
As per international guidelines ,
If someone’s BMI is >35 (Asia pacific 32.5) i.e class 2 or severe obesity and is suffering from any one comorbidities like Type 2 diabetes, high BP, high cholesterol, cardiac disease, sleep apnoea, NAFLD, PCOD, infertility etc, they can undergo a Bariatric surgery.
If someone’s BMI is >40 (Asia pacific 37.5) i.e. morbid obesity, then they can undergo Bariatric surgery irrespective of the presence or absence of comorbidities.
Am Afraid Of Surgery. It Can Be Painful
It’s done completely through keyhole technique. Patients are out of bed 2 hours after surgery walking normally.
Undergoing Surgery Will Affect My Duties. How Can I Spare So Many Days?
We adopt a special LapROSEtechnique whereby patient recovers very fast after surgery. He/ she is fit on the next day to go home. As a protocol, patients are discharged on the second day after surgery. It is called “weekend weight loss surgery” as most of them are fit to be on work by Monday after the procedure during the previous weekend.
Will I Be Bedridden After Surgery?
Absolutely not. You will be walking 2 hours post-surgery. There is no role or requirement for bed rest.
Is It Risky To Undergo Bariatric Surgery?
It’s a very safe surgery to undergo. The risk associated with bariatric surgery is the same as for Gallbladder and appendix surgery.
Is Bariatrics A Relatively New Discipline In The Medical Field?
It’s not new to medical field. The surgery is being done since 1960’s. initially it was done by open technique. From 1990’s the surgery is completely done laparoscopically i.e by key hole technique.
How Is The Surgery Done?
Surgery is done by keyhole or scar less laparoscopic technique. There are no big incisions and hence no pain. Recovery is very fast after the surgery.
How Long Should I Stay In The Hospital?
Usually patients are fit to get discharged on the second day after surgery. Rarely some patients may need to stay a couple of more days
How Does The Surgery Help?
Surgery increases the body’s metabolism by stimulating the gut hormone secretion. This directly signals the brain to send weight loss signals. Also there is reduced intake of calories and some malabsorption which aids in weight loss.
How Much Weight Would I Lose?
On an average one can lose 60% to 80% of the excess body weight. If the diet and activity protocol is strictly followed more than 80% of excess body weight is lost.
For instance, if the patient has 50 kg extra body weight, he/she is expected to lose 30 to 40 kgs on an average.
Will I Feel Weak And Tired ?
Surgery as such will not make you feel weak or tired. If you consume enough liquids daily and take proper protein supplement, you will not feel any weakness or tiredness.
Can I Eat Normal Diet After Surgery?
After one month you will be able to take normal diet. Immediately after surgery you will be on liquid diet which will be changed to pureed diet and then to normal diet.
How Do I Feel After Surgery? Tell Me How My Life Would Change After Surgery
There is a significant improvement in the quality of life after bariatric surgery. Losing weight makes you feel more lighter and brisk. Weight loss surgery patients gain back their self-confidence and energy levels. There is also a significant remission or cure of the comorbidities like diabetes, hypertension, cholesterol, sleep apnoea, joint pain, PCOD etc..
How Long Will It Take To Lose My Excess Weight?
The weight loss will happen for 12 months after the surgery. However, most of the weight loss happens in the initial 6 months. After 12 months the weight loss generally stops
Will My Diabetes And Other Problems Settle After Surgery?
Yes. Most of the diabetic patients can stop their medications immediately after surgery. Few patients may need to continue medications for few months. The duration and severity of diabetes as well as the existing pancreatic function determines the outcome.
Is The Resolution Of Problems Permanent?
Most of the problems are cured permanently. Long term follow up studies up to 10 years have shown good results.
Can I Recommend It For Type 1 Diabetics?
Till now this surgery is not approved for type 1 diabetes patients. Many procedures are still in the trial phase.
Can I Become Pregnant After Surgery?
Yes. One can become pregnant after 1 year. During the first year, though the fertility rate rises tremendously, body is losing weight and will not be suitable to support a growing foetus. It is always advisable to become pregnant after the weight loss stops.
When Can I Go To My Gym?
Six to eight weeks after the surgery you will be fit to go to gym.
Will I Have Loose Skin After Surgery?
Majority of the patients do not complain of this problem. Very few patients feel their skin to be loose which can be corrected after one year.
Are There Any Complications After Surgery?
Any surgery will have complications. However, the complication rate is very less for a bariatric surgery. In fact it is comparable to the commonly done gallbladder and appendix surgeries. You can discuss with the doctor to clearly understand about this.
What Are The Side Effects?
Usually there are not many side effects. Missing the supplements and protein drink can lead to vitamin and mineral deficiencies. Also consuming less fluids after surgery can cause some side effects like weakness and tiredness.
What Is The Pre-Operative Schedule ?
A thorough body check-up is done which includes blood investigations, heart and lung function evaluation. Our anaesthetist will check you for fitness. Once fit, the surgery can be done on anytime. You can get admitted the day before surgery to get prepared.
How Will Be The Day Of Surgery?
You can walk into the operation theatre. You will be comfortable there. A small injection is given to induce sleep. After that you will be given general anaesthesia and following which surgery is done. After surgery you will be in the observation room for 2 hours. You will be made to walk after 2 hours and can walk back to your room comfortably.
When Do I Feel Normal After Surgery?
After 2 hours of surgery you will feel near normal. Within 24 hours you should be feeling perfectly okay.
After Discharge , What Are The Things To Be Followed?
You will be given discharge medications to be taken properly. You need to come for review after one week when your sutures are removed.
Can I Skip My Medications ?
It is not advisable to skip your medications. Occasionally missing once is acceptable.
Will I Regain Weight After Surgery?
Bariatric surgery gives a durable and sustained weight loss. Rarely there is a chance of weight regain after few years of surgery. The chance of weight regain is more after a sleeve gastrectomy compared to a gastric bypass. Discuss with your doctor to select the best procedure that suits you.
