Obesity, Bariatric and Metabolic Surgery
It is important to understand the terms – Obesity, Bariatric surgery, Metabolic syndrome, and Metabolic surgery. Obesity is a chronic treatable disease, where an excess amount of fat accumulated in the body adversely impacts the overall health of the individual and also reduces life expectancy.
Obesity can affect every system in the body and predispose individuals to diseases like stroke, heart attacks, sleep apnoea, infertility, osteoarthritis, etc. It is classified based on the Body Mass Index (BMI): a BMI of 18.5 to 25 is normal, > 30 is obesity, > 40 is morbid obesity, and > 50 is super obese. For the Asian population, however, a BMI of > 25 is considered obese and > 37.5 as morbid obesity. Surgery for morbid obesity is called Bariatric surgery.
Metabolic syndrome includes a constellation of diseases which significantly increase an individual’s risk of developing life-threatening conditions like heart attack, stroke, cancers, kidney and lung problems, etc. Obesity, Type II Diabetes Mellitus (high blood sugars), Hypertension (high blood pressures), and Dyslipidaemia (high cholesterol) constitute Metabolic syndrome. Surgeries performed to control one or more components of this Metabolic syndrome are collectively termed as ‘Metabolic surgery’.
Treatment Options for Obesity:
- Diet & Exercise: Diet and exercise play an important role and are the first approaches for treating obesity. When these options fail individually, other methods are considered alongside diet and exercise.
- Medical Management: This domain has seen reasonable progress in recent years. When diet and exercise yield sub-optimal results, medications can help achieve desired goals. Medications work as long as they are continued and come with their own set of side effects. GLP-1 Analogues are a newer class with promising results.
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Endoscopic Procedures: These procedures
have shown benefits in select patients:
- Endoscopic Sleeve Gastroplasty: Here, the stomach is plicated endoscopically (through a scope from the mouth), reducing its capacity using a special stitch device. This procedure reduces appetite.
- Endoscopic Balloon: A balloon in the form of a capsule is swallowed. It inflates once inside the stomach, occupying space and reducing appetite. The balloon remains in the stomach for 6 months before disintegrating and passing through stools.
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Bariatric and Metabolic Surgery: Surgery
for morbid obesity, also known as Bariatric surgery, is a
‘tool’ to reduce weight. Some of these procedures have been
practiced for over three decades and are proven modalities
for weight loss. These surgeries are performed
laparoscopically (commonly referred to as ‘keyhole
surgery’), which significantly improves recovery, reduces
post-operative pain, and lowers morbidity.
- Sleeve Gastrectomy
- Roux-en-Y Gastric Bypass
- Mini Gastric Bypass
- Banded Procedures
How Does This Surgery Result in Weight Loss?
These surgeries reduce the size of the stomach, thereby decreasing the quantity of food consumed and suppressing hunger. More importantly, these operations induce changes in intestinal hormones (incretins & anti-incretins) that burn body fat, leading to gradual and sustained weight loss. These hormones also make cells more receptive to absorbing and utilizing blood sugar (reducing cell resistance) and stimulate better insulin production by the pancreas, aiding in diabetes control and improvement in other comorbidities.
Duration of Hospitalization, Diet After Surgery, and Follow-Up:
The average hospital stay is 3 to 4 days. No bed rest is required post-surgery, and patients are encouraged to walk as soon as possible. Liquids are started from the day following surgery and continued at discharge. Regular follow-up is crucial, during which patients receive guidance on diet and physical activity goals. Patients are encouraged to adopt healthy lifestyle practices, continue simple nutritional supplements, and actively participate in support group meetings.
Is the Surgery Safe?
Bariatric surgery has proven to be safe in multiple clinical trials. Its safety standards are comparable to other commonly performed operations like hernias and appendectomies.
