Bariatric Surgery
Laparoscopic Sleeve Gastrectomy
Laparoscopic Gastric Banding
Laparoscopic Roux-Y Bypass.
Morbid Obesity and Bariatric Surgery: 12 Questions and Answers
Dr Prakash K , MS, MCh, AFSAChief GI Surgeon, Aster Medcity, Kochi.
1. What is Obesity? What are the health hazards because of obesity?
Obesity means having excess body fat in relation to ones height and weight. Obesity generally is determined by calculating body mass index (BMI), which is calculated by the weight in kilograms divided by height in meters squared.
BMI Status 1
18.5 – 24.9 Normal
25 – 29.9 Overweight
30 – 34.9 Obese
35 – 39.9 SevereObesity
>40 Morbid Obesity
> 50 Super morbid Obesity
* Among Asian Indians, the recommended BMI for obesity surgery is >32.5 with co=morbid illnesses and >37.5 in Obese individuals. (Consensus Statement for diagnosis and treatment of Obesity, JAPI, Vol.57, February 2009.
National Institutes of Health and National Heart, Lung, and Blood Institute. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report. Obes Res 1998;6(suppl 2):1S-209S.
2. Please describe about health hazards of morbid obesity.
Severe obesity damages the body by its mechanical, metabolic and physiological adverse effects on normal bodily function. These “co-morbidities” affect nearly every organ in the body in some way, and produce serious secondary illnesses, which may also be life-threatening. The following are the excess risk of associated illnesses related to obesity.
Co-Morbidity Percentage of more risk 
Diabetes 20-40%
Hypertension 25-55%
Hyperlipidemia 35-53%
Cardiac disease 15-25%
Respiratory disease 10-20%
sleep apnea 20-30%
Arthritis 20-30%
Depression 70-90%
Stress Incontinence 40-50%
Menstrual irregularity 15-25%
With BMI > 30 there is 55% increase in mortality, 70% increase in coronary artery disease, 75% increase in stroke and 40% increase in diabetes. So, morbidly obese males between 25 and 35 have 12x the chance of dying as normal weight men. A morbidly obese adult has a 33% less chance of living to age 65 as that of a normal weight person. That is the reason why surgery for obesity has great relevance in treating the excess weight and cures/ improves most of these medical conditions along with the surgery.
3. What is Bariatric surgery? How is it different from liposuction?
Bariatric surgery involves surgical methods to restrict or to reduce absorption of food from stomach and intestine. This is not a cosmetic surgery. This procedure results in overall reduction in bodyweight and helps to improve associated medical disorders of excess bodyweight. Liposuction is a cosmetic surgery wherein part of body fat is removed using high power suction, which usually does not produce any sustained weight loss.
4. Is weight loss surgery right for everyone?
The short answer is no. Surgery is not a solution for everyone. We only determine whether a patient is right for surgery after a complete evaluation and discussion with the patient. Because weight loss surgery is a life-altering procedure, we want to make sure our patients are committed to making the lifestyle changes needed for a successful procedure.
5. How much exercise one should do for a good weight loss?
As a general goal, aim for at least 30 minutes of physical activity every day. Moderate aerobic exercise includes such activities as brisk walking or swimming. Vigorous aerobic exercise includes such activities as running and aerobic exercises. Because 3,500 calories equals about 0.45 kilogram of fat, you need to burn 3,500 calories more than you take in to lose .045 Kg. So one need to plan out caloric intake and do regular exercises to have good weight loss. Here is a chart to have an idea about how much weight loss you can achieve with diet and exercises.
Activity (1-hour duration) Weight of person and calories burned
70 kilograms 90 kilograms 100 kilograms
Aerobics, high impact 533 664 796
Aerobics, low impact 365 455 545
Aerobics, water 402 501 600
Bicycling, < 10 mph, leisure 292 364 436
Running, 5 mph 606 755 905
Running, 8 mph 861 1,074 1,286
Stair treadmill 657 819 981
Swimming 423 528 632
Walking, 2 mph 204 255 305
Walking, 3.5 mph 314 391 469
6. Who should undergo this procedure?
As a first line of treatment diet and exercises should be tried. Patients who had a trial of diet, regular exercise and probably drugs and failed to have a sustained weight loss must think about this surgery. Among Asian Indians, the recommended BMI for obesity surgery is >32.5 with co=morbid illnesses and >37.5 in Obese individuals. (Consensus Statement for diagnosis and treatment of Obesity, JAPI, Vol.57, February 2009.
7. How effective is weight-loss surgery? What are the benefits and is the effect long term?
These procedures help in reducing 50-85% excess body weight. The amount of weight you lose — and how fast you lose it — depends on which weight loss surgery you have. The amount of weight loss varies depending on the type of procedure chosen (usually done by the doctor). Along with weight loss most of the medical co-morbidities improve which in turn improves patients self esteem and confidence. Some of the important benefits are
Diabetes mellitus Type II in these patients improve and a vast majority of them become completely normal blood sugar levels normal after surgery.
Hypertension & high cholesterol improves significantly. These effects along with good amount of weight loss reduce risk for heart disease significantly.
There is good relief for sleep problems, apnoea and acid reflux symptoms.
As the body weight comes down body pain and joint arthritis improves very well.
Overall improvement in the sense of well being and self esteem.
The effect of these procedures is long term in terms of weight loss and improvement of co-morbidities, if the patient adheres to the follow up advice of the doctor.
8. What are the different Types of Bariatric Surgery Procedures?
All these procedures are done laparoscopically.
1. Sleeve Gastrectomy: In this procedure stomach is converted to a long tube-like structure to reduce its capacity. This is less complex operation and produces about 60-68% weight loss.
2. Adjustable Gastric Banding: In this procedure a ring like band is band is placed around stomach to convert initial part of stomach to a small pouch. No part of stomach is removed in this procedure and probably that is the disadvantage of this procedure as it produces about 50-55% of excess body weight-loss only.
3. Roux-en-Gastric Bypass (RYGB) procedure: Here the stomach is stapled to convert it to a small pouch and this helps in restricting food intake. Further a segment of intestine is bypassed from the food stream so that nutrients are exposed to less absorptive surface of small intestine. So this is a restrictive and malabsorptive procedure, which results in 65-75% of excess weight-loss.
9. How safe is bariatric surgery?
This surgery is very well established now and thousands of these procedures are being done worldwide. In expert hand and in centres with good facilities the mortality risk of these procedures is estimated as 0.3 per 100 procedures.
10. Will I need plastic surgery after bariatric surgery?
After having any form of bariatric surgery your body will undergo a dramatic transformation as a large amount of weight is lost. This weight loss is obviously the desired outcome with any weight loss surgery but a side effect of a large rapid weight loss is the potential to have large amounts of excess skin.
Skin does have some elasticity to it and will recoil or bounce-back when weight is lost. However when a large amount of weight is lost in a short period of time it is much more difficult for all the skin to bounce back so that there is no excess. This is when the patient must consider the option of plastic surgery to remove this excess skin.
11. Can I become pregnant after weight loss surgery?
Women should avoid pregnancy for at least 18 months after surgery. Please discuss any pregnancy plans with your surgeon during one of your clinic appointments.
12. What about medicines and follow up?
After surgery one need to have multivitamins, calcium tablets etc. if necessary as per the situation. You may need to observe some diet restrictions too for long term effects of the procedure, and in the initial few months you require follow up.