Cut that ugly fat!

Extremely obese individuals have the option of undergoing bariatric surgery to help them lose the excess weight

Illustration of slimming.A person with a healthy habit of regular light exercise can consume 1,500 calories a day. But, if he/she has a sedentary lifestyle, the calorie intake should be less. Obese individuals do not seem to have any pressing health concerns when they are young and therefore, do not consider any drastic steps to reduce weight. But, health problems are only lurking in the background and can emerge anytime. He/she could have diabetes, high blood pressure, heart problems, severe joint pain, backache, menstrual problems, infertility, and social and psychological problems.

Options in bariatric surgery

Bariatric surgery offers permanent cure through three methods: restrict eating, absorb less food or a combination of the two. In a restrictive surgery, the surgeon puts a band around the upper stomach [lap band] or makes the stomach to the size of a small tube by removing most parts of it [sleeve resection], so that the person’s ability to eat is reduced to just 15 per cent. The person thus loses weight due to his reduced capacity to eat.

In the second type, the surgeon conducts a bypass of the intestine. Most of the food bypasses [skips] the intestines where digestion takes place. This way, only a small amount of the food consumed is absorbed in the blood stream, and thus the weight is reduced.

The third method is a combination of the two. This is called the lap gastric bypass. Here the stomach is first made smaller by cutting, and then joined to the intestine, only to bypass a part of the intestine. This way the capacity to eat is restricted and the eaten food or liquid is also partly bypassed to restrict absorption.

Due to the minimal access method, surgeons can now conduct these surgeries with a small incision. The risks are less and so is recovery time. Bariatric surgery requires a multi-disciplinary approach because an obese person often has related health complications. Moreover, a surgery on an extremely heavy person requires a different setup of large operating tables and instruments and special expertise available only at elite hospitals.

Results of bariatric surgery

Most people lose 30 per cent of their weight after the first three years of surgery. But surgery does not mean the person is now free to eat anything. A lifetime benefit would require a lifetime commitment towards healthy eating. People who undergo stomach bypass need to be extra careful of their diet because less absorption could lead to malnutrition. They need to take supplements to augment their diet. Surgeons prefer the bypass method particularly for people who do not seem to be too compliant about diet restrictions.

M G Bhatt
Dr M G Bhatt, MS [General Surgery] and FRCS [England], is a consultant for gastroenterology and laproscopy at Wockhardt Hosptial, Bangalore, India.

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