However, the only treatment proven effective in long-term management of morbid obesity is surgical intervention (Bariatric surgery).
 
Surgery for morbid obesity (Bariatric surgery)

What is bariatric surgery?

Bariatric Medicine (Bariatrics) is a branch of medicine that deals with prevention, control, and treatment of obesity. Bariatric Surgery uses surgical means to control and treat obesity (Greek: baros = weight, iatreia = medical treatment).

Who is a good candidate for Bariatric Surgery?

• BMI more than 38 (kg/m2) 
• BMI more than 33 (kg/m2) with obesity related diseases
• The patient should have attempted weight reduction using medical treatment without success.
• The patient should understand the full importance of the proposed surgical procedure including suspected risks and complications.
• The patient should be willing to be observed and followed by a medical professional for many years.

What are the types of Weight Loss Surgery Procedures?

There are two basic mechanisms of weight loss surgery:

1. Restrictive procedures: These decrease food intake by creating a small upper stomach pouch with a smaller capacity.
2. Malabsorptive procedures: These allow consumed food to bypass parts of the intestine alter digestion, causing the food to be poorly digested and incompletely absorbed.

There are several procedures that combine the restrictive and malabsorptive mechanism of weight loss surgery. The risk of complications and side effects generally increase with the alteration of the digestive process.

Choosing between the different operative procedures involves the surgeon’s preference and consideration of the patient’s eating habits and particulars.

Procedures offered

1. Laparoscopic Adjustable Gastric Banding (LAGB)
2. Laparoscopic Sleeve Gastrectomy (LSG)
3. Laparoscopic Gastric Bypass (LGBP)

Laparaoscopic Adjustable Gastric Banding (Restrictive)

• An inflatable band is placed around the upper most part of the stomach separating the stomach into one small and one large portion
• Band can be adjusted to increase or decrease the capacity of stomach to hold food
• It acts by achieving early and prolonged satiety and reduced appetite
• Surgery can be reversed
• Digestion and absorption is normal, hence no long term need to supplement with medicines or special dietary products
• The weight loss is proved to be 50-70% of extra weight in 1-2 years time

Laparoscopic Sleeve Gastrectomy (Restrictive)

• The stomach is stapled so as to only keep 10-20% of functional stomach & the remaining stomach is removed
• The patients feels satisfied & full even after a small meal
• Surgery can be converted to malabsorptive procedure like Gastric Bypass or Bilio-pancreatic diversion easily, at a later date
• Digestion and absorption is normal,  hence no long term need to supplement with medicines or special dietary products
• The weight loss is proved to be 50-70 % of extra weight in 1-2 years time
• There is no foreign body (vis-à-vis band) in the body.

 Laparoscopic Gastric Byplass Roux-en-y (Combined Restrictive / Malabsorptive)

• A stapler is used to create a smaller, upper stomach pouch which restricts the amount of food that can be consumed
• A portion of small intestine is bypassed, thus delaying food from mixing with digestive juices to avoid complete calorie absorption
• Digestion and absorption is affected,  hence long term need to supplement with medicines or special dietary products
• An average of 80-90 % of excess body weight loss one year after surgery & after 10 to 14 years, patients have maintained 60% of excess body weight loss

Risks involved in surgery

Weight loss surgery, as with any other major surgery has risks which includes:

• An internal infection from leakage of digestive juices into the body cavity
• Wound infections (less with laparoscopic surgery)
• Hernias (less chances with laparoscopic surgery)
• Blood clots may cause serious conditions like pulmonary embolism
• Development of gall stones after weight loss
• Vitamins, minerals, protein deficiency in some cases

As with any other surgical procedure, there is a risk of death.

Weight loss and outcomes

Good follow up and patient compliance gives satisfying clinical results. You can expect to shed off (and importantly keep off) 30 - 60% of your excess body weight. With the change in eating habits, you get accustomed to eating less, and can achieve sustainable weight loss. This in turn leads to a healthier lifestyle with reduced risks of obesity-induced health problems. Exercise is an equally important component, not only battling excess body weight but also improving general health and well-being.

Surgery is not a ‘miracle cure’. It requires patient commitment and follow-up. It is important to follow all instructions regarding dietary advice, exercise and lifestyle modifications. "There is no gain without pain”. The fruits of your efforts lie in the results, which can change your life… for the better!

Benefits of weight loss surgery

• Significant weight loss in first 1-2 years
• The weight loss is permanent
• Improvement of Type II Diabetes
• Lowering of blood pressure
• Lowering of cholesterol
• Relief of sleep apnoea
• Relief of acid reflux
• Decreased joint pains, improve mobility of joints
• Improved mood & self esteem
• Improvement in efficiency
• Physical and social wellbeing

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