BARIATRIC SURGERY

Half of urban Indian population is obese and the highest risk of weight gain is seen in the most productive age-group of women and men from 28 to 38 years. While India battles under-nutrition on one side, obesity has emerged as the new emperor of all maladies.

Bariatric surgery/ weight loss surgery/ obesity surgery is the only proven method for sustained weight-loss in morbidly obese patients.

Obesity is classified as under:

Classification for Caucasians/ Westerners(Kg/m2) Classification for Asians

(Kg/m2)

Normal weight 18.5 – 25 18.5 – 23.5
Overweight 25 – 30 23.5 – 27.5
Class 1 obesity 30 – 35 27.5 – 32.5
Class 2 obesity 35 – 40 32.5 – 37.5
Class 3 obesity 40 and above 37.5 and above

 

BMI Formula:

BMI= (weight in kg)/Height in m2)

Obesity afflicts each and every organ of human body from head to toe. Obese patients are at a high risk of developing type 2 diabetes, high blood pressure and dys-lipidemia. All these diseases eventually lead to a substantial increase in the risk of heart disease in a person. Obesity also causes obstructive sleep apnoea, non-alcoholic fatty liver disease, gout, joint diseases, PCOD, obesity hypo-ventilation syndrome, increased risk of venous thrombo-embolism, gall stone disease etc. Obese patients are also at a high risk for developing certain kind of cancers such as breast and endometrial cancer in women and colon and pancreatic cancers in men.

Obesity and diabetes have together emerged as the new-age epidemic called “diabesity”. As the duration of diabetes increases in a person, so does the risk of heart disease.

 

Metabolic Syndrome

Obesity, diabetes and heart disease are deeply interlinked entities. Metabolic syndrome is a cluster of conditions that eventually lead to an increased risk of heart disease. 6 components of metabolic syndrome that relate to an increased risk of heart disease are as under:

  1. Abdominal obesity
  2. Atherogenic dys-lipidemia (this means that high cholesterol levels affect blood vessels and lead to blockages)
  3. High blood pressure
  4. Insulin resistance or high blood sugars
  5. Pro-inflammatory state
  6. Pro-thrombotic state

Morbidly obese patients may have one or more of the above components of metabolic syndrome and are at a much higher risk of heart disease as compared to normal weight population.

Bariatric Surgery/Weight loss surgery/Metabolic surgery/ Obesity surgery

Bariatric surgery or obesity surgery is the only proven method that leads to sustained weight loss. It also leads to a significant improvement in most of the associated diseases such as diabetes, high blood pressure, high cholesterol etc and reduces the overall risk of heart disease. Most bariatric surgery or obesity surgery procedures lead to about 60 to 75% excess weight loss. This depends on the type of weight loss surgery and the commitment from the patient and the team.

Eligibility for weight loss surgery

The IFSO- APC (International Federation for Surgery for Obesity and Metabolic Disorders – Asia Pacific Chapter) guidelines for weight loss surgery are as under:

  • Bariatric surgery/obesity surgery/weight loss surgery must be considered for the treatment of obesity for acceptable Asian candidates with BMI ≥ 35 Kg/m2 with or without any associated diseases.
  • Bariatric surgery/metabolic surgery must be considered for the treatment of type 2 diabetes or metabolic syndrome for patients who are inadequately controlled by lifestyle alterations and medical treatment for acceptable Asian candidates with BMI ≥ 30 Kg/m2.
  • Bariatric surgery/metabolic surgery may also be considered as a non-primary alternative to treat inadequately controlled type 2 diabetes or metabolic syndrome for suitable Asian candidates with BMI ≥ 27.5 Kg/m2.

Calculate your BMI:

BMI= (weight in kg)/Height in m2)

 

 

Types of bariatric surgery

 

Bariatric surgery is an evolving branch of medicine. There is a lot of research going on in this field. New procedures are being introduced every now and then. Bariatric operations performed by Dr. Aparna Govil Bhasker are listed as under:

 

  1. Laparoscopic Roux en y gastric bypass
  2. Laparoscopic sleeve gastrectomy
  3. Laparoscopic duodenal switch
  4. Laparoscopic adjustable gastric banding (not very popular any more)
  5. Endoscopic intra-gastric balloon insertion
  6. Laparoscopic single anastomosis gastric bypass (mini-gastric bypass)
  7. Laparoscopic sleeve gastrectomy with duodeno-ileostomy
  8. Laparoscopic sleeve gastrectomy with duodeno-jejunal bypass

 

Selection of the type of weight loss surgery/metabolic surgery/obesity surgery

 

As listed above, there are many types of weight loss operations. Which procedure suits you the best depends on many factors. These factors include the patient’s age, gender, weight, food habits, associated diseases, team and patient commitment etc. In our practice, you as the patient are equally involved in the decision making. Once the doctor evaluates you, the final decision about the procedure is taken after a mutual discussion between the doctor and the patient. Bariatric surgery is all about a lifestyle change and best results can be achieved only if the doctor and the patient work together as partners.

 

Preparing for surgery

 

Getting any surgery done is a major life decision. Trust and faith in your doctor and the team is very important. Having a positive frame of mind goes a long way in getting great results after the surgery. We do understand that surgery can be an intimidating experience for some people. Hence, we believe in hand-holding you through every step of the entire process. As you embark on this journey, rest assured that we will be with you at every step. The process begins with consultations with the doctor and the team. You will be advised certain tests and based on your reports and overall assessment, you along-with the doctor and the team will decide on the procedure that will work the best. Before the surgery, you will be on a high protein diet for a minimum of one week. Prior to surgery you may also need to see other specialist like an endocrinologist, nephrologist, chest physician etc based on your medical history. It is advisable to get admitted on the evening before the day of surgery.

 

Expected weight loss after bariatric surgery

 

Bariatric surgery or weight loss surgery leads to massive amounts of weight loss. On an average after any of the above-mentioned operations most patients will lose about 65 to 75% of their excess weight. This could be less or more depending on multiple factors such as post-operative diet, efforts put in terms of exercise, follow up by the bariatric team, associated co-morbidities, drug intake etc. Surgery leads to a considerable improvement in the quality of life of the patient and most patients are able to maintain atleast 50% of excess weight loss at the end of 5 years post surgery which is much higher than any other form of weight loss.

 

Improvement in associated diseases

 

Bariatric surgery/metabolic surgery leads to a significant improvement in associated diseases. Type 2 diabetes is seen to improve in 80 to 98% of patients. A significant number of patients do not need to take any medications for diabetes after the surgery. Ofcourse, this also depends on the duration of diabetes, status of pancreatic function, age of the patient and the BMI of the patient. High blood pressure improves in almost 70% of the patients. High cholesterol improves in 62% of the patients. There is an overall 80% improvement in metabolic syndrome. Surgery also leads to a marked improvement in other co-morbidities such as PCOS, joint diseases, gout, obstructive sleep apnoea, COPD etc.

 

Post-operative schedule for follow up

 

Regular follow up is the key to success after bariatric surgery. After surgery, you are expected to meet the doctor and the team atleast 3 times in the first year with your reports and once every year thereafter. There are many changes pertaining to your lifestyle, dietary habits, exercise schedule etc that need constant support and counselling. It has been seen that patients who follow up regularly tend to get better results.

 

We would like to reiterate that “follow up is the key to success after bariatric surgery”.

 

Cost of bariatric surgery

 

Bariatric surgery cost depends on a lot of factors. Cost of bariatric surgery can vary depending on the type of surgery, disposable equipment, type of room selected, duration of stay in the hospital etc. Weight loss surgery changes lives and surgery is said to cover its cost in less than 6 years. Studies have shown that patients who undergo bariatric surgery spend considerably less money in the long term as compared to patients who are on medical management for weight loss.

Cost of gastric bypass surgery is a little more than sleeve gastrectomy. Obesity surgery cost or metabolic surgery cost is not covered by all health insurance companies. Some insurance companies have now started covering the cost of weight loss surgery. Cost of obesity surgery is also covered by the central government health scheme (CGHS) for central government employees. Cost of metabolic surgery or bariatric surgery can also be paid by convenient EMI options that are being offered by some banks and companies now that provide interest free healthcare loans.