What is obesity?

The Center for Disease Control defines obesity as an excessively high amount of body fat in relation to lean body mass. It is commonly measured by Body Mass Index (BMI), which calculates the relationship of weight to height.

BMI Criteria-

BMI – Weight (ka)/(Height in mtr)2

  • Underweight: BMI< 18.5
  • Healthy Weight: BMI 18.5 – 24.9
  • Overweight: BMI 25 – 29.9
  • Obese: BMI 30 – 34.9 ( Class I Obesity)
  • Severe Obese: BMI 35 – 39.9 (Class II Obesity)
  • Morbid Obese: BMI > 40 ( Class III Obesity)

Morbid Obesity-

Obesity becomes morbid obesity when an adult is 45 kgs or more over ideal body weight / has a BMI of 40 or more / or has a BMI of 35 or more in combination with a health-related conditions such as abstructive sleep apnea or a disease such as type 2 diabetes or heart disease. Bariatric / weight loss surgery is a treatment option for patients suffering with morbid obesity. It is considered to be the most effective treatment for obesity in terms of maintenance of long term weight loss.

Moreover, it causes significant improvement in obesity-related comorbid conditions like Type 2 diabetes, high blood pressure, joint pains, sleeping disorders like apnea, heart disease, infertility issues and more.

What is Bariatric surgery?

Bariatric surgery is pertaining to weight or weight reduction using laproscopy. Bariatric surgery is performed using laproscopic technique (Keyhole surgery – minimally invasive). Bariatric surgical procedures cause weight loss by restricting the amount of food the stomach and hold, causing malabsorption of nutrients, or by a combination of both gastric restriction and malabsorption.

Common Bariatric surgery options which are available :

  • Gastric Bypass
  • Sleeve Gastrectomy
  • Minigastric bypass

Which patients should consider a Bariatric surgery?

To know whether weight loss surgery is an appropriate weight loss tool for you, let’s look at the medical guidelines established by the National Institutes of Health (NIH) for Bariatric surgery. Candidate for surgery should meet at least one of the following to criteria :

  • Have a Body Mass Index (BMI) of at least 40.
  • Have A BMI of at least 35 with one or more serious obesity – related conditions.
  • And meet both of the following criteria.
  • Have failed more conservative weight loss alternatives, such as supervise diet,exercise and behaviour modification programs.
  • Are at least 18 years of age.

There are other things to consider, too. You need to think about your determination and ability to make some serious changes in the way you live your life. Bariatric surgery is a tool to help improve your health. As with any new tool, you must actorly learn how to use it to get its best benefits.

How to evaluate surgical options ?

As you consider weight loss treatment with Bariatric surgery, it’s important to assesss your options using these critical factors :

Safety, effectiveness and support.

The choice of the surgical procedure depends on the treating surgeon and the team after evaluation and counselling.

Gastric Bypass

How it works to help you lose weight

Gastric bypass, which combines restrictive and malabsorptive surgery techniques. In this procedure, stapling creates a small (15 to 20cc) stomach pouch. The remainder of the stomach is not removed, but is completely stapled shut and divided from the lower stomach pouch. The outlet from this newly formed pouch empties directly into the lower portion of the jejunum, thus bypassing calorie absorption and the duodenum. To achieve this, the small intestine is divided just beyond the duodenum and a connection with the new, smaller stomach pouch is constructed. The length of either segment of the intestine can be increased to produce lower or higher levels of malabsorption.

Advantages

  • Limits the amount of food that can be eaten at a meal and reduces the desire to eat.
  • Average excess weight loss is generally higher than with gastric banding or sleeve gastrectomy.
  • No postoperative adjustments are required.
  • An analysis of clinical studies reported an average excess weight loss of 61.6%, in 4000 patient.
  • Shown to help resolve type 2 diabetes, high blood pressure, and obstructive sleep apnea, and to help improve high cholesterol.

RISKS

The following are in addition to the general risks of surgery:

  • Because the duodenum is bypassed, poor absorption of iron and calcium can result in the lowering of total body iron and predisposition to iron deficiency anemia. Women should be aware of the potential for heightened bone calcium loss
  • Bypassing the duodenum has caused metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back and fractures of the ribs and hip bones.All of the deficiencies mentioned above, however, can be managed through proper diet and vitamin supplements.
  • Chronic anemia due to vitamin B12 deficiency can occur. This can usually be managed with vitamin B12 pills or injections
  • When removing or bypassing the pylorus, a condition known as dumping syndrome can occur as the result of rapid emptying of stomach contents into the small intestine. This is sometimes triggered when too much sugar or large amounts of food are consumed. While generally not considered to be serious risk to your health, the result extremely unpleasant and can include nausea, weakness, sweating, faintness and, on occasion, diarrhea after eating

SLEEVE GASTRECTOMY

How it works to help you lose weight

A sleeve gastrectomy is a restrictive procedure that limits the amount of food you can eat by reducing the size of your stomach. During this procedure a thin vertical sleeve of stomach is created using a stapling device. This sleeve will typically hold between 50 to 150 ml, and is about the size of a banana. The excised portion of the stomach is removed.

Advantages

  • Limits the amount of food that can be eaten at a meal.
  • Food passes through the digestive track in the usual order, allowing vitamins and nutrients to be fully absorbed into the body.
  • No postoperative adjustment are required.
  • In clinical studies patients lost an average of 55% of their excess weight.
  • Shown to help resolve high blood pressure and obstructive sleep apnea, and to help improve type 2 diabetes and hyperlipidemia.

Risks

The following are in addition to the general risks of surgery:

  • Complication due to stomach stapling, including separation of tissue that was stapled or stitched together and leaks from staple lines
  • Gastric leakage
  • Ulcers
  • Dyspepsia
  • Esophageal dysmotility
  • Nonreversible since part of the stomach is removed

Minigastric bypass

The mini-gastric bypass procedure is restrictive and mal-absorptive. This means that the procedure reduces the size of your stomach, restricting the amount you can eat. The procedure also reduces absorption of food by bypassing up to 6 feet of intestines. Gastric bypass and the mini-gastric bypass are both malabsorptive and restrictive procedures.

THE WEIGHT LOSS SURGERY LIFESTYLE

Bariatric surgery is an effective weight loss treatment. But you have to do your part, too. Understanding and actively engaging in a lifestyle that supports achieving and maintaining a healthier weight is vital for success. Staying connected with your bariatric team is just as important.

PREPARING FOR BARIATRIC SURGERY

Whichever procedure you choose to have, it is important that you begin your new lifestyle preoperatively. Weight loss surgery should be considered one of the tools available to help you lose weight. A making appropriate lifestyle adjustment is crucial to the success of your procedure.

LIFE AFTER SURGERY

Diet

The modification made to your gastrointestinal tract will require permanent changes in your eating habits that must be adhered to for successful weight loss. Post-surgery dietary guideline will vary by surgeon. You may hear of other patients who are given different guidelines following their bariatric surgery. It is important to remember that every surgeon does not perform the same bariatric surgery procedure and that the dietary guidelines will be different for each surgeon and each type of procedure.

What is most important is that you adhere strictly to your surgeon’s recommended guidelines.

The following are some of the generally accepted dietary guidelines a bariatric surgery patient may encounter:

  • When eating solid food, it is essential that you chew thoroughly. You will not be able to eat chunks of meat if they are not ground or chewed thoroughly
  • Do not drink fluids while eating
  • Omit sweets and other high calorie foods
  • Omit carbonated drinks, milk shakes, high-fat foods and foods with high fiber content
  • Avoid alcohol
  • Limit snacking between meals

RETURNS TO NORMAL ACTIVITY

Your ability to resume presurgery levels of activity will vary according to your physical condition, the nature of the activity. And the type of bariatric surgery you had. Many patients return to full presurgery levels of activity within 6 weeks of their procedure. Patient who have had a minimally invasive laparoscopic procedure may be able to return to these activities within a few weeks.

BIRTH CONTROL AND PREGNANCY

It is strongly advised that women of childbearing age use the most effective forms of birth control during the first 16 to 24 months after bariatric surgery. The added demands pregnancy places on your body and potential for fetal damage make this a most important requirement.

LONG-TERM FOLLOW-UP

Although the short-term effects of bariatric surgery are well understood, there are still questions to be answered about the longer-term effects on nutrition and body systems.

Nutritional deficiencies that occur over the course of many years will need to be monitored. Over of many year will need to be monitored. Over time, you will need periodic checks for anemia (low red blood cell count) and vitamin B12, folate, and iron levels. Follow-up tests will initially be conducted every 3 to 6 months, or as needed, and then every 1 to 2 years. Follow-up care is recommended for life.

SUPPORT GROUPS

The widespread use of support groups has provided bariatric surgery patients with an excellent opportunity to discuss their various personal or other issues. Most learn, for example, that bariatric surgery will not immediately resolve existing emotional issues or heal the years of damage that morbid obesity might have had on their emotional well-being.

Most surgeons have support groups in place to assist you with short-term and long-term questions and needs.
Bariatric surgeon who frequently performs bariatric surgery will tell that ongoing postsurgical support helps produce the greatest level of success for their patients.

FIND OUT IF YOU’RE A CANDIDATE FOR BARIATRIC SURGERY

To know whether weight loss surgery is an appropriate weight loss tool for you, let’s look at the medical guidelines established by the National Institutes of Health ( NIH ) for bariatric surgery.

You may be a candidate for surgery if you meet at least one of the following two criteria:

  • Have a Body Mass Index (BMI) of at least 40
  • Have a BMI of at least 35 with one or more serious obesity-related conditions.

And meet both of the following criteria:

  • Have failed more conservative weight loss alternatives, such as supervised diet, exercise and behavior modification programs.
  • Are at least 18 years of age

There are other things to consider, too. You need to think about your determination and ability to make some serious changes in the way you live your life. Bariatric surgery is a tool to help improve your health. As with any new tool, you must actively learn how to use it to get the best benefits.

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