Weight loss surgery

Obesity is a major global disease with epidemic proportions and is not just a cosmetic problem. Weight loss surgery is the only accepted, standardized, and safe treatment option for obesity. 

The presence of an excessive amount of fat in your body leads to diseases. It puts you at risk of many other health issues.  Studies show that more than 50% of the world population is either obese or overweight. About five million people die every year in the world due to issues with obesity. Obesity leads to many health issues like diabetes, heart disease, stroke, etc.

Obesity and BMI

BMI or Body Mass Index is the most common indicator of weight classification. It considers your height and weight as the factors for its calculation. BMI is the weight of the person in kilograms divided by square of the height in meters. In the imperial system, BMI is the weight in pounds divided by square of the height in inches multiplied by 703.

This value indicates your weight group

• If your BMI is less than 18.5, you are underweight
• If your BMI is higher than 18.5 and lower than 25, your weight is healthy
• If your BMI is higher than 25 and lower than 30, you are overweight
• If your BMI is higher than 30, you are obese

Treatment for obesity

There are many methods to reduce weight. The right one for you will depend on your level of obesity, overall health, and commitment. The main methods are 

• Diet changes
• Lifestyle changes
• Physical exercises
• Medications
• Weight loss surgery

Weight loss surgery 

Weight loss or bariatric surgery is a proven treatment for obesity. You can go for weight loss surgery if

• Your BMI is higher than 35 
• Your BMI is higher than 32, and you have weight-related problems like diabetes or hypertension

However, the recommendation to perform bariatric surgery in Class 1 obesity(BMI 30.0-34.9) depends on many other patient factors and comorbidities. 

The goals of weight-loss surgery are 

• Reduce the intake of food by reducing the capacity of the stomach
• Lower the absorption of nutrients like fat, carbohydrates, etc.
• Create changes in gut hormone levels to suppress hunger and to reduce appetite and food intake 

Weight-loss surgery is a major life-changing decision. It also needs a commitment to a new way of life. So, you have to be sure about this before deciding to go for the surgery.

Types of weight-loss surgeries

There are two main variants of weight-loss surgery. They are

1. Restrictive surgeries: They restrict the amount of food that your stomach can hold. Since you will feel full quickly, you will eat less. They work by reducing the size of your stomach.
2. Malabsorptive surgeries: This surgery shortens and bypasses much of your small intestine. It reduces the amount of nutrients and calories that the body absorbs, thus reducing weight.

Some of the common types of weight-loss surgeries are listed below. They have all their benefits and drawbacks. Your doctor will discuss them with you and decide on the right option for you.

Gastric Bypass or Roux-en-Y Gastric Bypass

It is a combination of restrictive and malabsorptive types. In this, the surgeon will make a small pouch by dividing the stomach into two parts. The smaller part, which is the pouch, is connected to the lower part of your intestine. As the connection between the stomach and your intestine is still there, your stomach will continue to make the digestive juices that will flow to the small intestine.

Gastric bypass helps to reduce weight in multiple ways. First, as the size of the stomach pouch is small, it limits your food intake. Then, as the food bypasses a large part of the intestine, fewer calories and nutrients are absorbed. Finally, this bypass of the food stream leads to changes in your gut hormones, reversing the effect of Type 2 diabetes. 

Benefits of gastric bypass surgery

1. Leads to significant long term weight loss - you can lose about 80-85% of your excess body weight 
2. Weight loss will be faster than other procedures. You may lose up to 30% of your weight within six months.
3. Lesser chances of weight regain
4. Produces gut hormones that reverse the effect of Type 2 diabetes, PCOD, Dyslipidemia, Hypertension in many cases, Obstructive Sleep Apnoea(OSA).

Drawbacks of gastric bypass surgery

1. It is a complex surgical procedure.
2. Your food and nutrient absorption will be less. So you may need protein, iron, and vitamin supplements.
3. Chances of having dumping syndrome. In this condition, the food passes from the stomach to the intestine very quickly. Sometimes giddiness and blackouts have been reported with high calorie and hyperosmolar foods and beverages. However, it can also act as a protective mechanism against weight regain.
4. Rapid weight loss may precipitate gall bladder stones (which are deposits of bile in your gallbladder). However, we prescribe Urso deoxy Cholic Acid(UDCA) regularly after the procedure for its prevention.

Gastric sleeve surgery

In this restrictive method, the surgeon will remove about 80% of your stomach. The remaining part will be in the form of a tube banana that connects to the intestines. You will consume less food as the size is small. 

Benefits of gastric sleeve surgery

1. It is a simpler process than gastric bypass surgery
2. Weight loss of more than 50% over three years
3. Lesser chances of weight regain
4. There is no bypassing of the food stream. So, you will not have much issues with nutrition
5. Produces gut hormones which reverse the effect of Type 2 diabetes

Drawbacks of gastric sleeve surgery

1. You will have a long staple line with some incidence of postoperative leaks. Also, you may have bouts of gastric reflux after the procedure.
2. It can lead to long term vitamin deficiencies in some cases

Biliopancreatic Diversion with Duodenal Switch (BPD/DS) Gastric Bypass

It is the most complex weight loss surgery. This method is a combination of gastric sleeve and bypass surgeries. 

First, the surgeon will remove a large part of your stomach, like in a gastric sleeve. Then, the surgeon will divide the duodenum, which is the first part of the small intestine, near the stomach outlet. A portion of the distal, lower part of the intestine, is brought up and gets connected to the pouch. About three fourth of the intestine gets bypassed due to this. 

The surgeon will then reconnect the bypassed intestine to the last part of the small intestine. The bile and pancreatic juices will flow through this channel. 

Benefits of duodenal switch gastric bypass

1. It gives the maximum weight loss over a long period
2. You can eat almost near the normal quantity of food over time
3. Reduces fat absorption by more than 70%
4. Is the most effective option against Type 2 diabetes

Drawbacks of duodenal switch gastric bypass

1. It is the most complex weight-loss surgery
2. Needs a longer hospital stay
3. Needs regular follow-ups with doctors to avoid serious complications
4. Higher chance of protein and vitamin deficiencies

Other types of weight loss procedures

Gastric band: In this restrictive surgery, the surgeon uses an adjustable band to apportion your stomach. Your stomach will have a smaller upper section and a larger lower section. The band controls the size of the opening between the two parts in the stomach. It limits the amount of food that you can take before feeling full.  

The gastric band is a much simpler option compared to the other surgeries above. However, the effect of weight loss is also lower here. 

This method is obsolete now due to the advent of better methods like gastric sleeve.

Gastric balloon: In this, the doctor will insert a saline-filled balloon into your stomach through your mouth endoscopically. It makes you feel fuller with less food. It is a short term method for about six months. You may lose up to 10% of your excess weight through this. This procedure has the most risks and complications associated amongst all bariatric procedures.

Preparation for weight-loss surgery

As weight-loss is a major procedure, it is always better to prepare well for it. Here are some tips that you will help you prepare better.

• Know about the options, risks, and side effects. Have realistic expectations about the results. Reading about it, talking with others who have gone through this surgery, and discussing it with your doctor can help you.
• Stop smoking before surgery. Smoking can affect the outcome and also delay the recovery after surgery.
• Restrict coffee, soda, and alcohol
• Change to a healthy diet. You may even have to be on a liquid diet for 1-2 days before the surgery.
• Drink more water 
• Begin a moderate exercise plan and stick to it

Life after weight-loss surgery

You will have to make some short and long term changes after weight-loss surgery to have the best results. It helps to speed up weight loss and to maintain the loss.

Things that you should do at home after the surgery 

• Chew your food thoroughly
• Eat and drink slowly
• Drink plenty of water
• Make sure your diet contains enough vitamins, minerals and also proteins
• Exercise regularly as suggested by the doctor
• Never miss your meals even when not hungry

There are a few things that you should also avoid for the best outcome. These are

• Avoid carbonated beverages and keep your caffeine intake to a minimum
• Don’t smoke 
• Avoid alcohol altogether or at least limit it to a bare minimum
• Avoid binge eating