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Weight loss surgery or surgery for morbidly obese (body-mass index > 35) population has been in practice for decades. Laparoscopic approach to these types of surgeries has seen a renaissance of such operative procedures. as anyone can imagine that for an extremely overweight/obese patient undergoing surgery is not without serious risks . laparoscopy offers the following proven advantages for the patients undergoing obesity surgery:
lower risk of wound infections & hernia
better heart, lung and immune function after surgery
less pain after surgery
faster return to normal activity
no increase in the risk of serious complications
better cosmetic results
WHAT HAVE YOU GOT TO LOSE?
Some facts about obesity ...
What is obesity?
Obesity is a chronic disease involving an accumulation of excess fat sufficient to harm health. Individuals are considered obese if their BODY MASS INDEX (BMI) is 30 or higher. Obesity results when the size or number of fat cells in a person’s body increases. Obesity is often confused with being overweight. It is important to understand the difference because obesity is a disease and a serious life threat.
How will I know if I am obese?
The first thing you need to do is to find out whether or not you are overweight, and if you are, by how much? To do this you have to calculate your Body Mass Index (BMI). If your BMI is above is above 23 you are overweight and if it is above 30, then you are obese.
What is BODY MASS INDEX (BMI) ?
BMI is a mathematical formula which expresses the ratio between a person’s body weight and height.
BMI = WEIGHT IN KG./ HEIGHT IN M2
OVERWEIGHT: 23-29.9
OBESE: 30-34.9
MORBIDLY OBESE: > 35
What is Morbid Obesity?
Morbid obesity is a chronic, lifelong, genetically-related disease. It is defined by a BMI of 35 or above. When obesity becomes morbid, the excess weight puts life at risk. Morbid obesity is associated with a large number of debilitating and life-threatening disorders that have an impact on health & quality of life, while shortening life span. The term morbid obesity is synonymous with clinically severe obesity.
What are co-morbidities?
Obesity being a chronic disease is associated with a host of illnesses that seriously compromise health & reduce life span. These illnesses are called co-morbidities and include life threatening conditions like type 2 diabetes , high blood pressure, cancer, high cholesterol, snoring/sleep disorders(sleep apnoea) etc. when obesity becomes morbid these medical problems become life-threatening and the risk of dying prematurely from these diseases increases.
What is obesity/weight loss surgery?
Studies have shown that obesity surgery is the only proven method to loose weight & keep it off in the long term, when all other therapies have failed. Obesity surgery significantly decreases mortality rates & prevents the development of new obesity-related health conditions in morbidly obese individuals. It completely resolves or improves obesity-related co-morbidities. Risk of death for morbidly obese individuals is 89% higher if they decide not to have surgery.
How does obesity surgery work?
Changing the energy balance is the key to weight loss. Your energy balance is the relationship between how much food is absorbed and how much energy is used by your body.
Energy balance = food intake / energy expenditure
Obesity surgery reduces excess weight by one of the following mechanisms:
Reducing food intake (restrictive)
Reducing food intake absorbing less food consumed (restrictive & malabsorptive)
Moderate decrease in food intake & maximal reduction in absorption of food eaten (malabsorptive)
Am I a candidate for weight loss surgery?
Criteria to be met:
BMI is 35 or above
BMI is 30 or above with co-morbidities like diabetes, high blood pressure, cardiac problems, joint problems etc.
Failure to loose weight by non surgical methods like diet, exercise, medication etc.
Requirements to qualify for surgery:
Exclusion of weight gaining disorders (hormonal problems)
Willing to make a life long commitment to exercise & nutritional guidelines
No medical or psychological contraindications to anesthesia or surgery
No history of alcohol abuse or drug dependence.
What are the different options for weight loss surgery?
Procedures fall into three major categories:
Restrictive procedures
  
 e.g., gastric sleeve resection, adjustable gastric banding, these operations seal a portion of stomach to reduce the amount of food one can eat.
Malabsorptive procedures
 e.g. biliopancreatic bypass; these operations shorten the digestive tract to limit the number of calories that can be absorbed.
Combined Restrictive/Malabsorptive procedures
 e.g, gastric bypass.
How much weight can I expect to lose?
Depends on:
Age
Weight before surgery
General health
Ability to exercise
Commitment to maintaining dietary guidelines & other follow-up care
Motivation & support of family and friends
On an average at least 50% of the excess body weight is lost in 12-18 months
What will be the health benefits of this surgery?
Weight loss surgery can eliminate or improve most obesity related medical problems like diabetes, hypertension, high cholesterol, gastric reflux, muscle and joint pains, snoring, breathing difficulties etc. it will improve ones body image & reduce the symptoms of depression. It is also associated with improved fertility and favorable pregnancy outcomes.
What is most important is the ability to live life to the fullest. One is able to do all those things that look so normal but can not be done right now because of the excess weight like playing with your children , finding clothing that fits & looks good and finding comfortable forms of travel & accommodation.
Can one get pregnant after this surgery?
Yes. This is one of the benefits of obesity surgery, with improved fertility after the operation. However it is recommended to avoid pregnancy during the period of rapid weight loss i.e the first 12-18 months as the food supply to the foetus may be impaired.
What is involved in preparing for surgery?
One has to undergo a thorough medical evaluation to assess the eligibility for weight loss surgery. A meeting with dietician will evaluate the eating pattern and suggest an appropriate diet plan. A low calorie diet before surgery will help in reducing weight as well as the liver size which can be an impediment during surgery. In addition to loosing weight , this will enable us to assess the motivation & discipline , a pre requisite for success. Commitment to changed life style & behavior modification are extremely important as is the support of family & friends.
How long does it take to recover?
Most patients stay in the hospital for 2 days & are discharged when:
Able to ingest sufficient fluids to prevent dehydration
Have no fever
Have adequate pain control with medication.
One is able to enjoy regular routine in a week to ten days time.
How is the diet changed after surgery?
The nutritionist will discuss the diet plan before the discharge. However one has to prepare to an altered eating pattern to maintain a healthier life style & dedicate to following some proven guidelines for long term success. While it may be a challenge at first, it will help one enjoy the maximum benefits of surgery. It is very important to strictly adhere to the dietician & surgeon’s recommended guidelines.
After the procedure, one is on a liquid diet first, followed by blended or semi-solid foods. Gradually one moves back to a more regular diet of healthy, low fat, low calorie foods.
Following the dietary guidelines does not mean that one would not be able to enjoy life anymore. One can always go out & eat with family & friends. One just needs to learn new eating habits, which will help prevent overeating & unpleasant side effects.
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