Bariatric Surgery

The number of obese people continue to rise, and more and more people are turning to bariatric surgery as a method of quick weight loss. The ones who can afford it get it done without thinking twice.

Typically, bariatric surgery is advised for those patients who are at least 25 to 30 kilos overweight with BMI 32.5 or above. People with severe diabetes, hypertension or obstructive sleep apnoea associated with obesity are also likely candidates. Women who have irregular periods and are unable to conceive due to obesity can also opt for the surgery.
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Bariatric surgery can be performed on all kinds of patients except if they have an unstable heart condition or untreated angina, or are psychologically unstable in which case they dont understand/appreciate what is required after bariatric surgery and will not follow-up.

Bariatric surgery plays an important role in treatment of Type 2 diabetes by changing the hormonal levels in the blood. The insulin that is produced in the body becomes sufficient. Insulin resistance is increased and blood sugar is controlled. Over 80 % of the patients after the surgery will have normal blood sugar without medicines which is very significant because worldwide 60% of patients have uncontrolled blood sugar levels even with medicines.

Many instructions are given before surgery to ensure that the procedure is safe for the patient. Tests to evaluate fitness before surgery which include heart, lung and kidney check-up, liver function, cholesterol, etc. are conducted. If any correctable problem or deficiency is diagnosed in these tests, then it should be attended to. Most of the people who are overweight by 25 to 30 kg also have a fatty liver. Such patients are put on a diet for one to two weeks before surgery primarily to reduce the fat content of the liver and not for weight loss. Patients are also taught breathing exercises.

After the surgery, patients are discharged either the same day or after 24 hrs. They should be on a liquid diet for about two weeks to ensure healing after which they are advised to be on a soft diet for a while. They are also prescribed supplements of protein, vitamin, calcium and iron to compensate for the deficiency of nutrients during the healing period.

Lifestyle changes and weight loss after surgery

Bariatric surgery is just a tool. Making the right lifestyle changes is the most important decision that the patient needs to make. If patients eat good quality food and are physically active, they can lose anywhere between 70 to 95% of their extra weight. For e.g. if a person weighs 120 kg as against the ideal weight of 60 kg, he/she can expect to lose around 45 to 55 kg. The younger the patient, the better the weight loss is because young patients are more physically active.

Making the right food choices is paramount post-surgery. Since the quantity of food taken will be small, they need to eat protein-rich foods like pulses, milk products, eggs, fish, chicken, etc. Also, patients need to exercise, especially train with weights on a regular basis.

In some patients who have lost adequate weight after bariatric surgery the excess skin surrounding their pre-op fat becomes loose. This can be avoided by having enough proteins, water, vitamins, by exercising regularly and by getting body massages. After bariatric surgery less than 1% of the patients need plastic surgeries like tummy tuck or thigh lift.

It is a misconception that the surgery restricts the absorption of nutrients causing malnutrition. Most of the bariatric surgeries work on the principle of reducing the portion size and not on malabsorption. There are very few procedures which work on principle of malabsorption and are not done in countries where there are more vegetarians. It is possible that some patients may have malnutrition which can be completely prevented by following post-operative guidelines and having more proteins, vitamins, calcium and iron in their diet.