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Fighting obesity is a Herculean task. Many morbidly obese persons would eventually need bariatric surgery to win over obesity. The decision to undergo bariatric(obesity) surgery is in itself a very big decision. A person goes through a lot of doubt and fact-checking before the final decision is taken. Here, I have attempted to help all such persons by explaining some of their common doubts.
The first question that comes to one’s mind is, is this surgery for me? Do I need it? Would I benefit from this surgery? Do I have other simpler options than surgery? Here is a detailed discussion about these doubts in a easy to understand language.
Bariatric surgery is advised if your body mass index (BMI) is 32.5-37.5 with a weight-related medical condition. Also, if your BMI is 37.5 or greater even if you do not have any weight-related medical condition. You should have tried to lose weight through a change in diet and lifestyle before considering surgery. If you fall in the above-given BMI range, then you are less likely to lose and maintain weight with lifestyle changes. And hence the need for surgery.
In a situation where your weight is affecting your quality of life, surgery is even more justified. When obesity is leading you to have one or more medical problems like diabetes, blood pressure, swollen legs, breathing problems, and infertility, then delaying surgery may be more harmful in the longer run.
Bariatric surgery is not a cosmetic procedure. We may hope to look better after losing weight, but the best reasons for undergoing this major surgery are to extend and improve our lives. In addition to improving the quality of life, losing weight also reduce the risk of heart attack, stroke, diabetes, and cancer.
We must understand that it is not a surgery that is needed on an urgent basis. And the answer to the question “is it needed?” is never going to be a plain “yes” or “no”. It is always a conscious and well-thought decision, after understanding what are the benefits and the possible problems. For most of the patients who finally undergo this surgery, the benefits outgrow the possible problems.
Hence, you should understand what are the reasons for you to consider surgery. A consultation with a bariatric surgeon may help you in understanding that. Taking your weight into consideration, BMI, age, lifestyle restrictions, possible future complications of obesity into consideration.
Assume a case of a female aged 50 years with a weight of 95 kgs and a BMI of say 37 kgs/m2. And having varicose veins and swollen legs and knee and back pain. Unable to do physical activity properly and hence unable to lose weight even with a proper attempt with diet changes. There has also been an increase in weight of about 5-10 kgs in the past 1-2 years. Such a person should consider surgery with thorough understanding. Else she is likely to cause more damage to her knee and spine and finally will be forced to go for weight loss surgery after a few years. When her weight had increased to 105 kgs with passing time. This is so because she is less likely to lose and maintain weight loss with her knee and back problems and considering her age factor.
Now let’s discuss a different scenario, where the person is having a BMI of 42, with diabetes that is poorly controlled with medication, or having significant breathing or sleep apnoea problems. Under such a scenario, the risk of complications of surgery is much less compared to the risk of complications due to obesity and related medical problems. For such patients, uncontrolled diabetes can lead to kidney failure, diabetic foot ulcers, heart attack, and stroke. Their sleep apnea can lead to fatal accidents or can restrict their activity significantly.
There are a lot of such problems and scenarios where bariatric surgery will be a boon in spite of the possible complications. And with proper pre-surgery evaluation and a good follow up, the complications can not only be reduced but can be effectively managed in case they occur. So you need to understand your own problems and to what extent obesity surgery will be helpful. What are the other options in case you do not undergo this surgery?
Once you decide you want to undergo bariatric surgery, the next step is the selection of a surgery. There are various options, broadly Laparoscopic and Endoscopic.
Laparoscopic surgeries include:
Endoscopic procedures :
The most commonly done surgeries among the above are Laparoscopic sleeve gastrectomy and both types of gastric bypass. They are the preferred ones because they have shown consistent good long term results. Selection of surgery depends on factors like your BMI, your age, whether you are vegetarian, and most importantly your metabolic problems. Metabolic problems mean having diabetes, the need for insulin, altered cholesterol levels, and poor pancreatic reserve as shown by C peptide levels.
Bypass operations are little more complex surgeries but have a significant advantage for patients who have diabetes. While ileal interposition is for those patients who have diabetes and are not morbidly obese. It means it is a purely metabolic surgery, done to improve your diabetes.
Endoscopic procedures are not the ideal option for patients with a BMI of more than 32.5. Gastric balloon placement has not shown good long term results. Endoscopic Gastroplasty is still a new procedure and looking at the poor results of laparoscopic gastric plication (which is already abandoned), I am not too optimistic about the long-term outcomes of this procedure. Still, this can be considered in selected patients with BMI in the range of 30-32.5 and no metabolic problems.
The best and safest surgery for you may be different from the one for another obese person. Hence, a thorough discussion with a surgeon and understanding the outcomes of each procedure is advised before taking the decision. A Bariatric surgeon will help you figure out the risk vs benefit ratio for different surgeries in your particular case. And then you both can make a joint decision about the type of surgery to be performed.
No surgery is 100 percent safe and without any problems, and the same applies to Bariatric surgery. It is a major surgery and has its share of problems. Some of the initial problems of concern are bleeding, leakage from the joints in the intestine and stomach, breathing problems, and leg vein clots. There is a chance of about 1-2% (means 1-2 in 100 patients undergoing this surgery) of having any of these problems. Above problems may need further treatment, longer hospitalization, another procedure to deal with the problem, and may add to the total cost of treatment. All the measures to prevent these problems are certainly taken before, during, and after surgery. If we are aware and alert about it, identify and treat them on time, a major mishap can be avoided. Hence, it is important to be aware of these problems. Apart from this, there some other minor problems like wound infection, fever, vomiting which are not of major significance.
Overall, for the right indication of bariatric surgery, despite these complications, the benefit of this surgery is far more than the problems. When we follow proper protocols and with due care, these problems can be kept at a minimum and be managed effectively when they occur. Ultimately achieving positive outcomes.
Long term problems after bariatric surgery are mainly nutritional problems and weight regain. There are many factors that can lead to these problems. A good follow-up and an attitude to follow a healthy diet and lifestyle is the most important factor, that will help to avoid these problems.
So is anemia and trace element deficiency. Generally, they are being supplemented during the weight-loss period. They are a bit more likely to happen with bypass procedures compared to sleeve gastrectomy. A healthy diet helps in avoiding it, and a regular follow up help in detecting it early. Early detection makes its management very simple, just by supplementing. Some of the deficiencies if not detected on time can cause more problems and will be difficult to manage.
Rather than it being a complication of the surgery, it occurs due to the continuation of poor lifestyle on the part of the patient. It is not at all wrong in saying that, weight regain happens when a patient is unable to modify the primary culprit of their obesity, “the unhealthy lifestyle”. A poor follow up is an indicator of a casual attitude towards a lifestyle change. And so, the majority of patients who have nutritional deficiencies and weight regain have a history of poor follow-up after surgery. Follow up is the time when the bariatric team helps you in changing your unhealthy diet pattern and lifestyle to a healthier one. By guiding you, motivating you, by providing you the options that are better suited to you considering your age, medical problems, culture, work pattern, likings, and preferences.
After the surgery, you will find that it is not as painful as you have expected. You will be out of bed and moving around in a few hours. Certainly, it not going to be totally pain-free. But considering that it is major surgery, the pain is much less. It is so because of the laparoscopic methods. In a couple of days, you can expect yourself to be moving around normally. Walking as much as you want, climbing stairs, etc. Those who have table work or office work, they can return back to work within 7-10 days.
Initially, you will be on a liquid diet for 2 weeks. You will be able to take a sip of liquid at a time for the initial few days. Hence you will be expected to have a sipper around so that you can continuously sip liquids every few minutes. This is important as you need to maintain hydration by taking about 2-3 liters of liquids per day. Soon, soft food will be added and progressed gradually. The transition to a normal diet will take about 4-6 weeks. This is the period that will need some planning and adjustments. Especially when you resume work.
You can expect to return to work in about 8-10 days depending on the type of work you do. Some motivated ones can resume work even earlier. The earlier you start moving around normally and resuming work, the faster is your overall recovery.
Initial weight loss is fast. About 40-50 % of the expected weight loss is seen in the initial 3 months. The remaining weight loss will occur in the 12-18 months period. Amount of weight loss in the first month and the initial 3 months will depend on your excess weight. This initial weight loss is enough to make you feel lighter and more energetic. It will also boost your confidence. And hence, this is the time when you should gradually improve your physical activities to get the best outcomes.
Improvement in medical conditions is seen quite early. Diabetes starts improving from day one, even before the first kilogram is lost. This is the real magic of bariatric surgery, especially bypass surgery. The blood pressure, knee problems, back problems, leg swelling, and infertility all start improving in the initial few months. All this will help you get back to a healthier lifestyle.
Although bariatric surgery gives consistent good long-term results, the outcomes in an individual do depend on a lot many things. Patients, who understand this and follow the advice given by their surgeon get better outcomes. Here are a few factors that are very important and worth understanding.
The most important care is to eat slowly after chewing properly. This is important in the initial days, as eating fast may cause discomfort or even vomiting. With the passing time you will be able to understand yourself, at what pace you are feeling comfortable eating.
Secondly, you also have to develop the habit of eating the right foods. As nutritional deficiencies are a possibility, you need to eat healthy food. Food that is rich in proteins, vitamins, and fibers. You need to avoid soda, coffee, and sugary liquids. You also need to avoid sweets, chocolates, and fried food.
Change to healthier food needs to be done at a mental level. You need to understand and accept that this is the right way to eat and this habit should be lifelong. And it will be possible only if you are happily accepting it rather than forcing yourself. This is the single most important change that defines your long term outcome after surgery.
As already discussed, you should be able to resume normal activities in about 7-10 days’ time. At this point in time, you need to focus on gradually increasing your physical activity levels. Being active will help you achieve maximum weight loss and also help maintain muscle mass. Sagging of skin also reduces if you are physically active. With increasing weight loss, doing exercise will be more and easier. Here is one more thing I want to clarify you do not need to go to the gym but required that moderate exercise is to be regularly continued. Activities like brisk walking, running, playing, etc should be included in your daily habits. Due to this, the need for separate time for exercising is less. All this is what kept our ancestors healthy.
Protein and vitamin deficiency are a possibility and hence you need to follow the advice of your surgeon about the supplements. For the initial few months, protein supplements are generally required, till you reach a normal diet pattern. Vitamin supplements are needed for a longer-term, at least till you are losing weight. Further need for vitamin supplements will be suggested by the surgical team as per your needs.
After surgery, you need to careful with other medications. Always discuss with your surgical team before taking medications, especially NSAIDs and painkillers. Alcohol and smoking will also cause problems and hence need to be avoided. Smoking is very likely to cause ulcerations and may lead to major problems.
Follow-up is the single most determinant of good long-term outcomes. It is understandable that after a few months patients do not feel that they are patients. And hence they are very much likely to skip and avoid follow-ups. But this is the time when your surgeon can pick up early nutritional deficiencies, pick up your unhealthy diet and inactivity. Suggestions are given during the follow-up to help you adhere to a healthy lifestyle. Those patients who keep good follow-up are likely to have better outcomes.
The cost of surgery varies from place to place, hospital to hospital, and surgeon to surgeon. Certainly, as it needs a lot of sophisticated instruments and disposable material, the overall cost is higher. Although it is not needed to spend an exorbitant amount of money, some of the basic necessities should not be ignored to cut costs. If you want to inquire about the packages at our center you can send your details by clicking here and we shall be happy to communicate with you.
The surgeon and the surgical team is your partner in your fight against obesity. Hence choosing a good surgeon is very important. Some of the attributes are very important and hence you should make sure that your surgeon has those. He must be experienced and qualified in performing these surgeries. Surgery should be performed at a hospital having all the needed equipment in the operation theatre and should have an ICU backup facility. Your surgeon should be willing to give you time to sort out your queries and give genuine advice. Member of the bariatric team should be available to you any time after surgery for your small problems and concerns. If you can tick yes for all the above attributes then you are in safe hands.
We at ADROIT understand the problems of obese individuals. Not just what problems they are facing, but also why they are facing those problems. What are the challenges they are facing in the fight against their weight, physical, psychological, emotional, familial, social, financial, and professional? We also have a thorough understanding of the root causes of obesity. And have the ability and willingness to find the specific causes of each individual patient. This helps us guide them to achieve excellent long-term results. As a center, we are doing these surgeries regularly for a long time and can assure you of a safe and smooth recovery. Our team also takes active participation in making sure you are back to your normal routine life soon after surgery. These are probably the reasons why our patients rate us among the best.
Dr.Chirag Thakkar
