Weighing Up the Options of Weight Loss Surgery
Obesity can be one of the most difficult conditions to live with and can be associated with poor self-esteem, mental ill-health and unique social challenges. From a medical point of view, it is also one of the hardest conditions to treat and should be approached with empathy and compassion. If you’re an individual with a statistically high body-mass index (BMI), you may have tried a number of different lifestyle and pharmacological interventions. However, sadly, often these are found to be unsuccessful in long-term management.
There may be a point when weight-loss or ‘bariatric’ surgery is offered to you.
Many patients are unaware of what this involves and the long-term effects. Remember, if you are ever unsure about what a treatment means, always ask your GP. In the meantime, here is a brief summary of some facts you may want to know.
What is bariatric surgery?
There are three main types of procedures undertaken for weight-loss:
1. Lap banding
A silicone or plastic composite band is placed around the top part of your stomach, with an inflatable balloon attached. This compresses the wall of your stomach, creating a small pocket of functional stomach space. The walls of this portion of stomach expands rapidly when eating leading to a faster sensation of ‘fullness’ or satiety. The band also slows down the passage of food from this part of your stomach to the rest of your gut. Overall, while your gut is all intact (no parts have been removed through surgery), you will be more satisfied with smaller portions of food and ideally lose weight thereafter.
A gastric band is normally introduced by ‘laparoscopic’ (keyhole) surgery, as a day procedure by a general surgeon or specialist bariatric surgeon – where the colloquial term, ‘lap banding’ comes from. The amount of pressure in the balloon coating this band is adjustable by your surgeon or weight-loss doctor through a port just under the skin, and may be increased to further limit the rate of release of food from your stomach pouch into the rest of your gut.
2. Sleeve gastrectomy
This procedure may also be done through keyhole surgery and involves removal of part of your stomach, reducing your overall stomach volume by about 80%. The remaining part of your stomach continues to function normally, secreting acid and aiding in the digestion of your food.
3. Gastric bypass
A gastric bypass is the most radical of the commonest bariatric procedures and involves re-plumbing of the intestines to allow passage of food from the very upper part of the stomach straight into the first part of the intestine. This procedure, called a ‘Roux-en-Y bypass’ carries the highest rate of weight loss – up to 35% - also carries a higher risk of complications including nutritional deficiencies.
How effective is it?
All three procedures are effective in causing weight loss between 20 and 35% and each have their distinct advantages. The nature of lap banding makes it reversible if complications were to occur and it is adjustable in the meantime to better tailor your weight loss. On the other hand, the non-reversible forms of bariatric surgery have slightly more profound rates of weight loss in the long term. Bariatric surgery can assist in reversing the course of Type 2 diabetes, especially with bypass surgery. Following bariatric surgery, patients often undergo radical levels of weight loss as soon as they leave the operating room. This can improve general health, increase exercise tolerance and improve self-esteem.
Is it safe?
As with all surgery, there are complications. Risks specific to weight-loss surgeries include:
Nutritional deficiency: due to the changed nature of your digestive anatomy, some vitamins including B12/folate and other elements including iron etc. suffer from poorer absorption. It is important to liaise with your GP or dietician/nutritionist to optimise your dietary intake.
Gastric bands can occasionally erode into the wall of the stomach
Gastro-oesophageal reflux or ‘heartburn’.
Dumping syndrome: a syndrome that refers to the rapid emptying of the stomach after eating seen in people with gastric bypasses. It causes a feeling of weakness, stomach discomfort and urgent opening of bowels.
Leakage at the site of surgical stapling: this can often present as pain and will invariably require re-operation.
Weighing up the options – what now?
If you think you might be a candidate for weight-loss surgery or have type 2 diabetes and are worried about your BMI, it might be worthwhile broaching the topic with your GP. Your GP may then refer you onto a specialist surgeon to discuss what options are right for you.
Not everyone is suited to this kind of weight-loss measure. Perhaps you have other medical issues that prevent you from going under the knife, or more importantly, under general anaesthetic. Surgery also requires a specific mindset that not everyone is equipped with right away. Lastly your GP or wider healthcare team might advise to try other methods first that are safer and better suited to your needs.
If you do end up being a candidate for surgery, it is important to recognise that surgery is not the only measure necessary for effective weight loss and then even if surgery is a viable option it will only be effective in combination with diet and exercise measures. But don’t despair, help is out there and the best way to lose weight is with the support of your GP, dietician and exercise therapist or personal trainer.
All the best of luck on the next leg of your adventure!
Grima, M. and Dixon, J. (2013). Obesity: Recommendations for management in general practice and beyond. Australian Family Physician, 42(8), pp.532-541.
Grosse, C. (2018). RACGP - Discussing bariatric surgery in general practice. [online] Racgp.org.au. Available at: https://www.racgp.org.au/newsGP/Clinical/Discussing-bariatric-surgery-in-general-practice [Accessed 28 Mar. 2018].
Lee, P. and Dixon, J. (2017). Bariatric–metabolic surgery: A guide for the primary care physician. Australian Family Physician, 46(7), pp.465-471.
Lim, R. (2018). UpToDate. [online] Uptodate.com. Available at: https://www.uptodate.com/contents/bariatric-operations-for-management-of-obesity-indications-and-preoperative-preparation [Accessed 28 Mar. 2018].
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