Out of options: When bariatric surgery is the answer

MINDY YARTAŞI
ISTANBUL
Published 10.11.2019 12:46
A patient consults her dietician. (iStock)
A patient consults her dietician. (iStock)

The struggle to maintain a healthy weight is even more difficult for those considered morbidly obese and often the best option is to undergo life changing weight-loss surgery to jumpstart the commitment to a healthier lifestyle

A common misconception is that obesity is caused by laziness or a lack of effort to lose weight, when often it is quite the contrary. Though it's true that we are what we eat, so to speak, genetics and chemical imbalances also play important roles in how our bodies process and store fat. The truth is some gain weight easier than others.

With almost 30% of the world's population, or around 2 billion people, obese or overweight, fad diets, treatments and weight loss, or bariatric surgeries continue to inspire controversial headlines focused on the "obesity epidemic" and fuel debates over growing waistlines. Of the three popular approaches, bariatric surgeries are the most permanent, life altering and sometimes controversial routes for those looking to lead healthier lives.

Related health issues

"Obesity can lead to serious health problems, including cardiovascular diseases, like heart disease or strokes, diabetes, musculoskeletal disorders, high cholesterol, sleep apnea, shortness of breath and chronic heartburn as well as psychological conditions like depression and anxiety," said associate professor Dr. Fatih Çiftçi, a specialist in bariatric surgery at Istanbul's Memorial Hizmet Hastanesi.

A high body mass index (BMI) can also increase your risk of certain cancers. According to a report by the U.S.-based National Cancer Institute (NCI), chronic low-level inflammation caused by conditions and disorders attributed to obesity can lead to changes in DNA that greatly raise the risk of developing certain cancers. For example, the NCI report explains: "Obesity is a risk factor for gallstones, a condition characterized by chronic gallbladder inflammation, and a history of gallstones is a strong risk factor for gallbladder cancer."

Why surgery?

Years of trying to diet and exercise with little or no results can be extremely frustrating and demoralizing for those overweight or obese. For morbidly obese individuals, their extra weight also makes it difficult to maintain an exercise regime and the energy levels needed to yield results, creating a vicious demoralizing cycle. Many think that weight-loss surgery is "cheating" to lose weight, but nothing could be further from the truth. The surgery is not a magic wand, but rather a jumping block in the right direction.

Who qualifies for surgery?

Obesity is determined according to the BMI, which is a simple calculation of the person's height and weight. To quality for weight-loss surgery, the patient's BMI must be at least 35 but preferably 40, which is considered morbidly obese. A person with a normal BMI falls within the range of 18.5-24.9, while one is classified as overweight when their BMI is 25-29.9 and obese at 30 or higher. For example, someone who is 175 centimeters, or 5 feet 9 inches, tall would have to fall within 56 to 76 kilograms, or 125 to 168 pounds, to have a normal BMI. In the case of our 175-centimeter example, morbidly obese would weigh in at 123 kilograms or more.

When evaluating a patient several factors are considered in addition to their BMI, including nutrition, weight history, medical conditions, motivation and age. "Patients are not only considered according to their BMI. They also must present other obesity-related health issues to be candidates for a surgery and have worked with a dietician for at six months with little results to qualify for surgery," Çiftçi explained.

Another factor included in the evaluation is psychological status. According to the Mayo Clinic: "Certain mental health conditions may contribute to obesity or make it more difficult for you to maintain the health benefits of gastric bypass surgery. These may include binge-eating disorder, substance abuse, anxiety disorders, major depression, schizophrenia, severe bipolar disorder and issues related to childhood sexual abuse."

The procedures

There are two types of bariatric surgeries: restrictive and malabsorption. Without interrupting the normal digestive process or reducing the absorption of calories and nutrients, restrictive procedures create a small pouch either by stapling off a small section of the stomach, a procedure called a sleeve gastrectomy, or using an adjustable gastric band to restrict a section to limit the amount of food the stomach can hold. In contrast and more invasive, malabsorption procedures, a gastric bypass or a Biliopancreatic Diversion with Duodenal Switch (BPD/DS), divert the flow of bile and pancreatic enzymes away from food thus limiting the digestion and absorption of nutrients and calories by reducing the stomach's size and redirecting the small intestine, which leads to weight loss.

"The most frequently preformed bariatric surgery in both Turkey and the U.S. is the sleeve gastrectomy due to its low risk of complications, the simplicity of the procedure and its high success rate. This procedure only requires a two-night stay in the hospital, and patients can generally return to work within 10 days. Only 3 percent of patients experience side effects following the surgery, the most frequent being anemia and a deficiency in vitamin B12," according to Dr. Çiftçi.

Following surgery, the majority of weight loss is experienced within two years. After the procedure, patients are placed on strict diets starting with only fluids for the first two weeks and slowly working up to normal solids by six to eight weeks post-op. To maintain weight loss, patients are advised to consume around 800 calories a day, and once they reach their goal, go up to the normal 1,200 calories daily. The sleeve gastrectomy has a long-term success rate of around 73% in patients five years after surgery.

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