Dr Poornima Subrahmanya

All About Weight Loss Surgery

The Modern Challenge of Obesity

Obesity is a pressing concern in today’s world. As reported by the World Health Organization, an alarming 650 million adults and 42 million children under five are grappling with obesity. Defined by a body mass index (BMI) of 25 kg/m2 or higher, obesity is recognized as a chronic condition affecting individuals of all age groups globally.

 

The surgical procedures performed to manage obesity are collectively referred to as metabolic or “bariatric” surgery. While bariatric surgery, or weight loss surgery, is often misconceived as a mere cosmetic intervention, it’s a life-saving procedure for many. These surgeries, which have seen significant advancements in recent years, can be life-altering for those combating obesity.

 

The challenge with obesity is its complexity. Many perceive it as a simple lack of willpower, but it involves intricate metabolic changes that can make weight loss an uphill battle.

Who should consider undergoing weight loss surgery?

Weight loss surgery is primarily for those battling severe obesity and associated health issues like type 2 diabetes, hypertension, and sleep apnea. However, there are specific criteria to determine if someone is a suitable candidate.

They are as follows:-

  • A BMI exceeding 35 without any accompanying obesity-related health issues.
  • A BMI over 30 accompanied by conditions such as type 2 diabetes or other obesity-induced health complications.
  • Prior unsuccessful attempts at weight loss through conservative measures.
  • Age between 18 and 65 years. However:
  • Those above 65 may still be considered if they present severe obesity-related health problems or disabilities.
  • For those under 18, special consideration is given based on recommendations from a pediatrician or endocrinologist, but only after the individual has reached puberty or achieved skeletal maturity.

Consideration should be given for race. There is growing evidence that the prevalence of diabetes and cardiovascular disease is higher at a lower BMI in the Asian than in the non-Asian population due to a higher prevalence of truncal obesity .

Thus, BMI criteria can be lowered by 2.5 kg/m2 per class, and those with BMI more than or equal to 27.5 kg/m2 can be offered bariatric surgery rather than 30 kg/m2 as above.

Types of Bariatric surgeries

People assume there is one single type of surgery, however in reality, there’s an array of procedures, with Laparoscopic Sleeve Gastrectomy being the most frequently performed. Each method is tailored to the individual’s needs. Some of the procedures are listed as follows.

 

  • Laparoscopic adjustable gastric banding(LAGB)
  • Laparoscopic Sleeve Gastrectomy(LSG)
  • Laparoscopic Roux-En-Y Gastric bypass(LRYGB)
  • Laparoscopic Mini-Gastric Bypass(MGB)
  • Biliopancreatic Diversion with Duodenal Switch(BPD-DS)

While all surgeries carry some risks, bariatric procedures are among the safest and the mortality rate is extremely low (0.1%). Recent advancements have further reduced complications, making it a viable option for many. For most people, the risks of obesity are much greater than the risks of bariatric surgery.

Is surgery a mere shortcut to losing weight?

You will definitely lose weight, but bariatric surgery is only one component of a multimodal treatment for obesity. In addition to undergoing fitness and psychological tests, surgical candidates meet with a dietitian to make the necessary lifestyle changes to help maintain their weight loss after surgery.

 

The entire process typically takes four to six months. The goal is to help patients develop healthier habits over the long term. If you don’t change your food habits and watch your portion sizes, you’re likely to regain the weight a few years after the surgery.