One of the major changes in medical practice as a result of obesity has been the introduction of bariatric surgery.
Bariatric surgery is a term used to describe a group of medical procedures introduced to deal with the growing obesity epidemic by aiding weight loss. Procedures under this category include;
Gastric band surgery where the stomach is tied so that the patient can feel full after eating less food.
A gastric bypass sees the top of the stomach being attached to the small intestine so that the patient feels fuller quicker and absorbs less calories.
A sleeve gastrectomy has part of the patients stomach removed so that they cannot eat as much.
Obese people, those with a BMI over 40 or greater, are eligible for bariatric surgery. Some people that have a BMI of 35 to 40 are also considered if they have other health concerns such as diabetes type 2 or heart disease.
Patients will need to have demonstrated that they have tried other methods of weight loss prior to being accepted for surgery. This includes having made changes to their diet and increasing exercise and that these methods have either failed to deliver results or failed to have maintained weight loss results. Once the decision to go ahead with surgery has been confirmed, patients will also need to commit to long term follow up appointments and to keep to lifestyle changes.
The benefits of surgery are that it can aid significant weight loss. With this weight loss comes the benefit of a decrease in life changing illnesses such as a reduction in type 2 diabetes, a decrease high blood pressure and an increase in mental health.
These benefits may occur slowly. Weight loss can take up to 2 years and involves the patient making significant long term changes to their lifestyles. Will power and perseverance are required to see this procedure all the way through to better health and wellbeing.
Patients are supported throughout the process as part of their after care. Counselling sessions are provided where required as well as advice from nutrition consultants and health coaches.
As with all types of surgery there are risks, these include;
Directly after surgery there is a risk of wound infection
Blood clots may occur in the legs or lungs. With this in mind it is essential to watch out for early symptoms to avoid serious complications. Things to look for include pain or swelling and redness in the lower leg, stabbing chest pain, shortness of breath or feeling faint.
Within the first 30 days following surgery in the UK there is a 1 in 1400 risk of death, whilst this is low it is something to consider particularly when exhausting other possibilities first.
Malnutrition may occur as not enough nutrients are absorbed by the body or the incorrect diet being followed following surgery. It is therefore necessary to ensure that supplements are taken to ensure that the recommended amount of vitamins and minerals are absorbed.
It has been reported that gallstones may develop in the first few years after surgery which can lead to discomfort or further treatment.
If the gastric band slips out of place food can leak between the joins in organs or intestines can become too narrow or be blocked entirely.
As weight loss can take several years to have a significant health impact the patient may lose motivation and their mental health may suffer. Or as the patient needs to commit to further lifestyle changes they may fall back into bad habits by overeating/ ignoring the full feeling and rupturing organs/ bands.
Female patients are advised not to become pregnant within the first 12 to 18 months after surgery to recover from surgery as well being aware that special diets will need to be followed to aid weight loss which may not be healthy for a developing foetus.
After losing weight the patient may be left with excess fold of skin that may need further surgery to remove. The mental health impact of this should be considered as well as the means for removing the skin such as what funding is available to them for this.
Once bariatric surgery has been considered a viable option it means that the patient has explored most other avenues open to them for taking control of their obesity without medical intervention. There are several effective alternatives which can be tried as a stepping stone between lifestyle changes/ willpower alone and irreversible surgery.
Drugs can be prescribed which prevent the intestine from absorbing some fat. The fat is then excreted in the faeces instead, if the diet isn’t changed and the levels of fat intake remain high unpleasant side effects can occur including fecal incontinence and cramps. The drug has side effects such as dry mouth and high blood pressure. As some vitamins need fat to be absorbed and used effectively within the body the patient will need to be aware of increasing certain foods in the diet or using supplements.
A more temporary surgical procedure is to insert a gastric balloon into the stomach for 6 months to see if the patient is able to change their habits enough to lose weight. This is an ideal alternative for those under the BMI for bariatric surgery or to see short term effects quickly to gain control over other health complications or prepare for surgery where weight loss is required.
Endoscopic sleeve gastroplasty uses an endoscope to cinch the stomach making it smaller and narrower meaning the patient should eat less food as well as food consumed taking longer to digest. The treatment results have showed weight loss, although slightly less than with lacroplosic sleeve gastoplasty, but with lower risks and costs.
In conclusion bariatric surgery is ideal for those people where at home methods of losing weight have failed to provide long term health benefits. Which ever method of weight loss is chosen it is important that patients are provided with regular after care appointments from several specialists to help support diet and lifestyle changes. If they were to continue along the same path as they were on pre surgery they will not lose enough weight or avoid further complications. Knowing which decisions led to obesity in the first place will help the patient to gain control of their weight with the added support of the surgical procedure. Having a successful procedure may not be seen for several years and support should be continued throughout this transition to ensure obesity is a thing of the past for each patient.
