Obesity: Treatment: Bariatric & Metabolic surgery
Dr Siddhartha Bhattacharya
Consultant at Peerless Hospital
Advanced Laparoscopic GI & Bariatric Surgeon
MS (Gen Surg), DNB (Gen Surg), FNB (Minimal Access Surg), Fellowship in Bariatric & Metabolic Surgery, MNAMS, FMAS, FAIS
* Former Consultant in Chennai
In recent times there has been a dramatic rise in the number of obese individuals in the Indian population. This increasing prevalence of obesity has been linked to numerous factors like westernization of Indian diet, an abundance of food, reduction in physical activity, stress and lack of sleep amongst various other factors. It is also essential to understand that obesity is not just a weight problem and is associated with a large number of associated diseases like type II diabetes mellitus, hypertension, lipid disorders, obstructive sleep apnea (OSA), cardiovascular diseases, fatty liver, polycystic ovarian disease, infertility, osteo-arthritis, and it even increases the risk of cancers. So it will not be wrong to say that it is truly “the emperor of all maladies.”
India being the diabetes capital of the world, the combined problem of obesity & diabetes, or as it is called Diabesity, is even more concerning. Morbidly obese patients with diabetes benefit enormously by weight loss as it reduces the requirement of medications and improves glycemic control. This eventually leads to reduction in risk of development of secondary complications of diabetes like nephropathy, retinopathy, peripheral neuropathy, and others.
World Health Organization (WHO) has recognized obesity as a chronic disease which requires treatment. Many patients suffering inflicted by obesity suffer in silence, not knowing the remedy. Many patients fall prey to dangerous unscientific methods of weight like fad diet and medications, which harm them more than benefit. It is, thus, imperative to treat obesity scientifically under the care of a dedicated multi-disciplinary team including dieticians, fitness trainers, psychologist, endocrinologists, and bariatric surgeon offering a tailor-made treatment for each patient. The treatment approach to such patients is step-wise, offering lifestyle modifications as the first step. Patients who fail to achieve weight loss by such measures can consult a Bariatric surgical team.
As described above, bariatric/metabolic surgery is not the first option for treatment; nevertheless, it is the most effective therapy for morbid obesity and its associated diseases (co-morbidities). Bariatric surgery affords long term weight loss with sustained improvement of co-morbidities. Resolution of diabetes after bariatric surgery occurs in close to 80% patients (Buchwald, Henry, et al. "Bariatric surgery: a systematic review and meta-analysis." Jama 292.14 (2004): 1724-1737.). Patients are entirely off medications for diabetes maintaining normal blood sugar levels. Hypertension, lipid disorders, and OSA also have very high-resolution rates. Bariatric surgery results in improvement in both quality & quantum of life.
Talking about the quality of life, it has both health-related and social implications. Many obese individuals face social stigma in personal as well as professional life. This leads to poor self-esteem and mental health problems. After bariatric surgery patients report higher confidence and better body image which improves their quality of life.
Who is eligible for bariatric/metabolic surgery?
As per the Obesity & Metabolic Surgeons Society of India (OSSI) guidelines, any patient with a body mass index (BMI; calculated as weight in kgs/ height in M2) of more 35 without co-morbidities, and any patient with a BMI of more than 30 with obesity-related co-morbidities (eg. Type 2 diabetes, hypertension, OSA) having failed to achieve weight loss by lifestyle modifications, can be recommended for bariatric surgery. A patient with severely uncontrolled diabetes, not responsive to all forms of medication can be offered bariatric/metabolic surgery at a BMI as low as 27.5.
Is bariatric surgery safe?
The safety profile of bariatric surgery is well established, both in the short-term as well as in the long term. However, bariatric patients need to maintain an annual follow up with the bariatric team (this checkup is similar to a yearly fitness checkup everyone should undergo). A yearly checkup ensures that the patients do not develop any nutritional deficiencies and also any maladaptive behaviors which may lead to weight regain. Major postoperative complications like anastomotic or staple line leaks are extremely low in experienced hands, to the tune of 1 in 1000 cases, which is even lower than the risk in a lap cholecystectomy (gall bladder removal surgery).
Bariatric treatment is a journey towards betterment of one’s life making an unbreakable bond between the patient and his/her doctor. The happiness which we see on the faces of bariatric patients after they lose weight and other associated problems brings great satisfaction to us.