Obesity is a well recognized public health problem. It is a risk factor for the development of a variety of illnesses including heart disease, varicose veins, back problems and stroke.
These days, the general public are a lot more aware of the risks associated with obesity and make every attempt to try and lose weight through diet and exercise.
However, in some people, despite every effort of theirs, weight loss just does not seem to occur. Such individuals can be offered bariatric surgery, also called weight loss surgery.
Indications for bariatric surgery
Bariatric surgery is offered to morbidly obese individuals in whom conservative treatment measures such as diet and exercise have failed. Treatments are offered in specialist centres and require extensive evaluation before consideration for the procedure.
Who can be offered bariatric surgery?
The general guidelines seem to be the same all across the world; in particular patients who have a BMI of more than 40 who have failed to lose weight despite six months of attempted weight loss strategies are offered the surgery.
An important aspect bariatric surgery is a patient commitment. Once the surgery has concluded, it is essential that patients commit themselves to a lifestyle that is healthy to avoid putting weight back on again. Furthermore, the surgery can only be offered to patients who are fit enough to undergo general anaesthesia and surgery. It is usually offered to older patients as younger people can attempt to lose weight through diet and exercise first for a little longer.
It is worthwhile noting that not everybody who is overweight will be offered bariatric surgery. Initial assessments can take anywhere between 1 to 3 months, and even after these, the patient may not be offered the surgery.
Types of bariatric surgery
There are a number of different types of bariatric surgery. Restrictive bariatric surgery involves reducing the size of the stomach through gastric banding using laparoscopy or removal of a small part of the stomach. Malabsorptive bariatric surgery involves creating a diversion within the bowel loops. Other bariatric surgeries include a gastric bypass and intragastric balloon.
The video below briefly discusses bariatric surgery.
Gastric banding through laparoscopy involves placing a tightening around the stomach just below the junction where the food pipe meets the stomach. It works by slowing down the entry of food into the stomach, thus regulating the amount of food the person ingests.
A gastrectomy is a procedure where a large chunk of the stomach is removed; leaving behind a small part of it that appears like a sleeve. It is also called sleeve gastrectomy. Once this procedure has been conducted, it cannot be reversed. Following a sleeve gastrectomy, the stomach is almost non-existent and food directly passes through the food pipe into the small bowel.
A gastric bypass procedure involves the creation of a pouch that connects the food pipe directly to the jejunum. The food that is ingested bypasses the stomach and the duodenum.
The choice of operation depends upon the patient’s fitness to undergo surgery, the treatment centre where the procedure is being offered and how obese the patient is.
Benefits of bariatric surgery
There are a variety of benefits that accompany bariatric surgery. In particular, weight loss is the most important benefit. Patients tend to start to lose weight within a few weeks and within a few months have lost a significant proportion of the abdominal fat and body weight.
In fact, this loss of body weight has been shown in studies to reduce the future risk of development of heart disease, diabetes and stroke.
But the benefits of bariatric surgery are not just limited to health benefits. Patients also experience a psychological benefit, with increased confidence being one of them. Enhanced body image perception is yet another benefit.
The video below talks about this aspect further.
Risks and complications
As is the case with any surgical procedure, bariatric surgery also bears certain risks and complications. One such risk is the development of clots in the legs and the migration of clots into the lungs. This condition is called venous thromboembolism and can be easily managed by administering preventative doses of blood thinning medication such as heparin.
In the rare cases, the gastric band may slip and leak in which case the procedure may need to be repeated. Infection of the site of the gastric band is a rare complication.
Bypass surgery can be complicated by leakage, ulcer formation and bowel obstruction. Patients may feel nauseous and may vomit as well. Narrowing of the site of the bypass i.e. stenosis may occur.
A well-recognized complication in patients who undergo gastric bypass surgery is called dumping syndrome. Here, patients experience palpitations, diarrhoea and light-headedness. Patients are advised to consume small meals in case this competition occurs.
In the rare cases, patients may not get sufficient amount of nutrients from the food that they consume and as a result may become malnourished. This needs to be kept an eye out for and if required supplements may need to be taken.
The video below discusses the complications of bariatric surgery.
Some patients may not experience sufficient weight loss following the procedure. Another side of this coin is that they may experience too much weight loss and may not be able to regain that weight. In the event that this occurs, or if the bariatric surgery operation fails, repeat surgery is rarely offered unless deemed absolutely necessary.
Bariatric surgery is a commonly sought after weight loss option. Individuals all across the world who have attempted to lose weight through diet and exercise and have failed may be offered this procedure. However, selection criteria are rather strict meaning only a select few patients who the health care professional team feel would benefit from this procedure will be offered bariatric surgery.
Once the surgery has concluded, it is the responsibility of the patient to ensure that they follow a strict diet and exercise plan will help bring the way down and reduce the chances of developing a variety of illnesses such as heart disease, diabetes, vascular disease and stroke in the future.
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