Being overweight is no longer treated as a mere lifestyle issue. Today, obesity is considered as nothing short of a disease, and a very dangerous one at that, as it is often a precursor to a host of other complications, such as cancer, diabetes, hypertension and many others. Bariatric surgery resets the set point of the healthy weight in a person. Essentially, it helps bring back the patient from the unhealthy weight range to the healthy range by natural means. The underlying principle of bariatric surgery is to restrict the food intake and reduce the absorption of food in the stomach and the intestines. It is an option for people having a body mass index (BMI) of 40 and above. It involves restricting the size of the stomach and slowing down digestion and removal of parts of the digestive tract (gastric restriction) and restricting the absorption of calories. Through such steps, this surgery seeks to address the issues of obesity and overweight and ensure a trimmed waistline.
Bariatric surgery is usually performed when the weight loss efforts through lifestyle changes and medications have been unsuccessful. There are two types of bariatric surgery: Restrictive procedures decrease the size of the stomach, thus lowering its capacity to hold food and leading to a lesser intake of food. Malabsorptive procedures decrease the absorption of calories in the small intestine. Before the procedure begins an intravenous line is used for medications and sedatives. It requires a general anaesthesia. A breathing tube inserted through the mouth will help in the person breathe during the procedure. A Gastric Bypass is both restrictive and malabsorptive procedure, because it decreases the size of the stomach and reduces the absorption of calories in the small intestine. Laparoscopic method is a modern technique of performing this surgery, where a laparoscope and surgical tools are inserted through small incisions in the abdomen. Banding techniques are restrictive procedures which decrease food intake by shrinking the stomach to a small pouch and making a tiny opening from the pouch to the stomach. Since food moves slowly, the person feels full sooner and for a longer time. There are some other methods of performing this surgery which are all based on either of the two principles. For all the methods, the surgeon will close the incisions with staples or stitches. After the surgery, the patient is taken to a recovery area where he/she will be monitored carefully. The person will be given pain medications and the diet will be gradually advanced over several days.
After the surgery, it is very important to not regain the lost weight again. It may be because of a mechanical problem in the operation due to dilation of the sleeve or bypass. In this case, a repeat operation may be performed. In most cases however, it is due to imbalance in diet. A high-protein diet containing very less amount of carbohydrates is very important in maintaining the weight loss and preventing weight gain after the surgery.
In the immediate period after the surgery, in the first couple of weeks, the person is on a liquid diet comprising of water, clear broth, soups, and milk and fruit juices. For the next two weeks up to a month after the surgery, the person should be on a diet of thick soups such as pureed fish, creamy yoghurt etc. Gradually, in the second month the person can start consuming solids. A person can resume his/her normal diet about two or three months after the surgery.
Myth: Bariatric surgery is a cosmetic procedure.
Fact: Bariatric surgery is a metabolic surgery which is done through laparoscopy where the size of the stomach is reduced to an extent or food is made to divert from the stomach to the latter part of small intestine. It aids in weight reduction and ameliorates other conditions such as diabetes, high cholesterol, joint pains etc.
Myth: Bariatric surgery can be avoided by addressing the problems of severe obesity through a diet and exercise regime.
Fact: People who are affected by severe obesity are usually resistant to weight loss for prolonged periods of time by exercise and diet. In such cases, a weight-loss surgery is usually the only answer. Some bariatric procedures cause biological changes that help limit the energy intake and increase production of certain gut hormones, which enhance satiety.
Myth: Pregnancy and delivery may be unsafe after bariatric surgery.
Fact: After the surgery, the cycles become regular and fertility improves. But, one should avoid getting pregnant for about one year after the surgery due to accompanied weight loss.
Myth: All types of bariatric surgery are the same and one can opt for any type.
Fact: On the contrary, a person with diabetes would likely need a gastric bypass where the size of the stomach is reduced and made to bypass a portion of the small intestine. Those with excessive BMI (greater than 50) may undergo a sleeve gastrectomy which removes a major portion of the stomach.
Myth: Patients may turn into alcoholics post-surgery.
Fact: Most of the people who turn into alcoholics after the surgery are those who have had problems with alcohol abuse in the past. Bariatric surgery increases sensitivity to alcohol.
Bariatric surgery is extremely effective in properly selected patients. Those who are psychologically ill-prepared for this surgery or those suffering from any disease causing weight gain may not benefit much. Generally speaking, more than 95% of patients will have definite benefits after this surgery.
The relation between type 2 diabetes and obesity/ bariatric surgery is very complex. Uncontrolled type 2 diabetes makes any surgery riskier, but properly controlled diabetes will not have any major impact on the risks of bariatric surgery. In fact, after undergoing this procedure, about 80% of the type 2 diabetics will be able to stay away from all their medicines for a prolonged period of time.
Currently, there are no medications available in form of powders or drinks which can aid in weight loss, although there are a couple of medicines in the pipeline stage which should be taken only under the supervision of a doctor.
Liposuction is not a tool or an operation for weight loss; it is designed for body shaping by removing fat from under the skin. It causes little or no impact on the weight loss of a person. If the risks arising out of this procedure are taken into account as in any other surgery, it is safe enough to be performed on teenagers. However, the motive behind undergoing a liposuction should not be to lose weight. It is performed only for shaping up the unsightly or sagging parts of the body due to excessive fat underneath the skin. The only answer for an effective weight loss over prolonged periods of time is bariatric surgery.
Abdominal operations such as hernia definitely makes the bariatric surgery a little more complicated, but are not contraindications for this if performed by safe and experienced pair of hands.
If done in properly selected patients, there are virtually no side effects of this surgery aside from some usual, minor complications which are common for every surgical procedure. Adequate care should be taken to consume a high-protein diet with regular vitamin and mineral supplements for a substantial period of time.
There are numerous health benefits. Apart from the obvious ones such as becoming thinner and looking better, a person also becomes fitter and more active. An individual suffering from diabetes, high blood pressure, hypertension, obstructive sleep apnea etc. will see a marked improvement from such diseases. It is also possible that many of them may be able to stop their treatments for such diseases altogether. Most importantly, this surgery can boost the life span of an individual by at least 5-10 years.
Generally, the age bracket for a bariatric surgery stretches from 18 to 65 years of age. However, in some exceptional cases, if the health benefits outweigh the risks, the surgery may be performed outside this age span as well. In children and adolescents, bariatric surgery is performed if they are overweight and if they have otherwise achieved a reasonable amount of physical maturity.
Mild exercises such as brisk walking and light stretching exercises can be resumed about a week or ten days after the surgery, while strenuous exercises such as weights should be avoided for about 2-3 months.
It is advisable, but not absolutely mandatory to go on a diet about a fortnight before the surgery.
Some people might experience post bariatric hair loss for up to six months after the surgery. But this hair loss can be mitigated and reversed to a large extent through a high-protein diet and vitamin supplements.
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