Bariatric

Obesity is a condition when BMI (Body Mass Index = calculated as body weight in kgs / Height in meters2) is above 30. In Asia, considering diseases such as diabetes, hypertension, heart attacks occur at a lower BMI, the cutoff has been reduced to 25.

Obesity leads to many diseases such as diabetes, high blood pressure, heart disease, snoring, joint pains, infertility, fatty liver, reflux, hernias, stones and cancers. Based on current literature, it is seen that patients with obesity live less than the non-obese and their quality of life is also inferior.

The first line treatment is a weight loss diet and physical activity. This should be supervised by trained professionals as there is a large body on non-evidence based treatment available for obesity. Sometimes weight loss drugs are prescribed but they produce modest results and come with some side effects that patients should be aware of.

Bariatric surgery is a keyhole surgery for obesity. Since it is done by keyholes, patients usually have a 24-48 hour hospital stay and have mild pain that can be controlled with oral pills. Many patients confuse bariatric surgery with liposuction. This is different since in liposuction, only fat beneath the skin is extracted and can lead to weight loss of about 5- 10 kgs from a region. Bariatric surgery on the other hand involves a gastrointestinal surgery that leads to decreased appetite, pronounced weight loss (30% of body weight) and resolution of diabetes, sleep apnoea and arthritis.

The main procedures are Sleeve gastrectomy and Gastric Bypass. In the former, the stomach is excised at the left side leaving a banana shaped stomach tube with a capacity of 200 ml approximately. This produces early satiety and certain neurohormonal changes leading to weight loss. Gastric Bypass involves creating a small gastric pouch and then joining it to the small intestine bypassing about 50 – 200 cm. The latter adds variable degree of malabsorption to the procedure. This has been claimed to have improved response on diabetes. There are two versions of this procedure- conventional and mini-gastric-bypass. It is important to discuss the pros and cons of each procedure with the doctor to finalise what is best.

There are issues of bleed, leak, infection, chest infection, pulmonary embolism, and heart attacks in the short term. In the long term, there are risks of ulcers, reflux, malnutrition, hernias, dumping (post prandial giddiness) and weight regain. Many of these can be prevented with diligent follow up and surveillance.

Most hernias will need surgery. The general principle is to repair the defect with a mesh – a flat piece of plastic net compatible with human tissue. Some hernias can be left without operation especially in the elderly when there is an unfavourable risk-benefit ratio.

Patients feel full after eating a lesser quantity of food. They are expected to take healthier diet with more proteins and fibers. A multivitamin supplement is prescribed for daily intake. Patients are encouraged to take up sports, exercise or gymming to maintain healthy body weight.