Obesity or excess weight is associated with high morbidity and mortality. India is capital of heart disease with one foot on obesity and other on diabetes.Obesity increased heart disease related mortality by 4 times and cancer related mortality by 2 times.
Choosing a Type of Weight Loss Surgery
Considering weight loss surgery? As you do your homework to see if it's a good choice for you, you'll want to learn about the various types of operations.
What's best for you depends on your goals, your health, your surgeon's recommendation.
Talk it over with your doctor so you can make an informed decision. Weight loss surgery is not for everyone. Doctors only recommend it for people who:
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Have a body mass index (BMI) of 40 or more. This would be about 100 pounds overweight for men or 80 pounds for women.
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Have a lower BMI (but are still obese) and have a serious health problem related to obesity, such as heart disease, type 2 diabetes, severe sleep apnea, or high cholesterol.
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Have tried unsuccessfully to lose weight by other means.
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Fully understand the Pros and cons.
Weight loss surgery can be lifesaving, but you need to be dedicated to making dramatic and permanent changes to how you eat, exercise, and live.
Classification of Weight based on BMI
|
CLASSIFICATION |
FOR
EUROPIDS -
WHO(1998)
|
CLASSIFICATION |
FOR ADULT
ASIANS - WHO -
WPROb (2008)
|
|
BMI (kg/m2) |
BMI (kg/m2) |
|
UNDERWEIGHT |
<18.5 |
UNDERWEIGHT |
<18.5 |
|
NORMAL RANGE |
18.5 - 24.9 |
NORMAL RANGE |
18.5 - 22.9 |
|
OVERWEIGHT |
>25 |
OVERWEIGHT |
>23 |
|
|
25 - 29.9 |
|
23 -24.9 |
|
|
30 - 34.9 |
|
25 - 29.9 |
|
|
35 - 39.9 |
|
>30 |
|
|
>40 |
|
|
a. Body Mass Index = Weight in Kg/ (Height in meters)2
Types of Weight Loss Surgeries
Existing surgeries help with weight loss in different ways.
Restrictive surgeries work by shrinking the size of the stomach and slowing down digestion. A normal stomach can hold about 3 pints of food. After surgery, the stomach may at first hold as little as an ounce, although later that could stretch to 2 or 3 ounces. The smaller the stomach, the less you can eat. The less you eat, the more weight you lose.
Malabsorptive/restrictive surgeries change how you take in food. They give you a smaller stomach and also remove or bypass part of your digestive tract, which makes it harder for your body to absorb calories. Doctors don't do purely malabsorptive surgeries -- also called intestinal bypasses .
Adjustable Gastric Banding
What it is: Gastric banding is a type of restrictive weight loss surgery.
How it works: The surgeon uses an inflatable band to squeeze the stomach into two sections: a smaller upper pouch and a larger lower section. The two sections are still connected by a very small channel, which slows down the emptying of the upper pouch. Most people can only eat a 1/2 to 1 cup of food before feeling too full or sick. The food also needs to be soft or well-chewed.
Pros: This operation is simpler to do and safer than gastric bypass and other operations. You get a smaller scar, recovery is usually faster, and you can have surgery to remove the band.
You can also get the band adjusted in a doctor's office. To tighten the band and further restrict your stomach size, the doctor injects more saline solution into the band. To loosen it, the doctor uses a needle to remove liquid from the band.
Cons: People who get gastric banding often have less dramatic weight loss than those who get other surgeries. They may also be more likely to regain some of the weight over the years.
Risks: The most common side effect of gastric banding is vomiting after eating too much too quickly. Complications with the band can happen. It might slip out of place, become too loose, or leak. Some people need more surgeries. As with any operation, infection is a risk. Although unlikely, some complications can be life-threatening.
Sleeve Gastrectomy
What it is: This is another form of restrictive weight loss surgery. In the operation, the surgeon removes about 75% of the stomach. What remains of the stomach is a narrow tube or sleeve, which connects to the intestines.
Sometimes, a sleeve gastrectomy is a first step in a series of weight loss surgeries. For some people, it's the only surgery they need.
Pros: For people who are very obese or sick, other weight loss surgeries may be too risky. A sleeve gastrectomy is a simpler operation that gives them a lower-risk way to lose weight. If needed, once they've lost weight and their health has improved -- usually after 12 to 18 months -- they can have a second surgery, such as gastric bypass.
Because the intestines aren't affected, a sleeve gastrectomy doesn't affect how your body absorbs food, so you're not likely to fall short on nutrients.No life-long supplements required .
Cons: Unlike gastric banding, a sleeve gastrectomy is irreversible.Patient experiences early satiety and incase tries to overeat may throw out or experience a few episodes of vomiting.
Risks: Typical risks include infection, leaking of the sleeve, and blood clots.
Gastric Bypass Surgery (Roux-en-Y Gastric Bypass)
What it is: Gastric bypass is the most common type of weight loss surgery. It combines both restrictive and malabsorptive approaches.
In the operation, the surgeon divides the stomach into two parts, sealing off the upper section from the lower. The surgeon then connects the upper stomach directly to the lower section of the small intestine.
Essentially, the surgeon is creating a shortcut for the food, bypassing part of the stomach and the small intestine. Skipping these parts of the digestive tract means that the body absorbs fewer calories.
Pros: Weight loss tends to be swift and dramatic. About 50% of it happens in the first 6 months. It may continue for up to 2 years after the operation. Because of the rapid weight loss, conditions affected by obesity -- such as diabetes, high blood pressure, high cholesterol, arthritis, sleep apnea, andheartburn -- often get better quickly.
Gastric bypass also has good long-term results. Studies have found that many people keep most of the weight off for 10 years or longer.
Cons: You won't absorb food the way you used to, and that puts you at risk for not getting enough nutrients. The loss of calcium and iron could lead to osteoporosis and anemia. You'll have to be very careful with your diet, and take supplements, for the rest of your life.
Another risk of gastric bypass is dumping syndrome, in which food dumps from the stomach into the intestines too quickly, before it's been properly digested. About 85% of people who get a gastric bypass have some dumping. Symptoms includenausea, bloating, pain, sweating, weakness, and diarrhea. Dumping is often triggered by eating sugary or high-carbohydrate foods, and adjusting your diet helps.
Unlike adjustable gastric banding, gastric bypass is generally considered irreversible. It has been reversed in rare cases.
Risks: Because gastric bypass is more complicated, it's riskier. Infection and blood clots are risks, as they are with most surgeries. Gastric bypass also makes hernias more likely, which may need further surgery to fix. Also, you may get gallstones because of the rapid weight loss.
Mini –Gastric bypass /Omega loop bypass/Single anastomosis bypass
What it is: It combines both restrictive and malabsorptive approaches.
In the operation, the surgeon divides the stomach into two parts, sealing off the one section from the other. The surgeon then connects the upper stomach directly to the lower section of the small intestine at 150-200cms.
Pros: Weight loss tends to be swift and dramatic. About 50% of it happens in the first 6 months. It may continue for up to 2 years after the operation. Because of the rapid weight loss, conditions affected by obesity -- such as diabetes, high blood pressure,high cholesterol, arthritis, sleep apnea, and heartburn -- often get better quickly.
Gastric bypass also has good long-term results. Studies have found that many people keep most of the weight off for 10 years or longer.
Cons: You won't absorb food the way you used to, and that puts you at risk for not getting enough nutrients. The loss of calcium and iron could lead to osteoporosis and anemia. You'll have to be very careful with your diet, and take supplements, for the rest of your life.Acid reflux may be experienced by patients sometimes.
Another risk of gastric bypass is dumping syndrome, in which food dumps from the stomach into the intestines too quickly, before it's been properly digested. About 85% of people who get a gastric bypass have some dumping. Symptoms includenausea, bloating, pain, sweating, weakness, and diarrhea & hypoglycemia episodes. Dumping is often triggered by eating sugary or high-carbohydrate foods, and adjusting your diet helps.
Unlike adjustable gastric banding, gastric bypass is generally considered reversible. It has been reversed in few cases.
Which Weight Loss Surgery Is Best?
The ideal weight loss surgery depends on your age, health,understanding,co-morbid medical conditions,medical history and body type.
For instance, if you are very obese, or if you have had abdominal surgery before, simpler surgeries might not be possible. Talk with your doctor about the pros and cons of each procedure.
No matter where you are, always make sure that your surgeon has had plenty of experience doing the procedure you need.
