Bariatric surgery, also known as weight loss surgery, is a type of surgery that is performed on individuals who are severely overweight or obese. The goal of the surgery is to help individuals lose weight and improve their overall health. Bariatric surgery is recommended for individuals who have a body mass index (BMI) of 35or higher, or a BMI of 27.5 or higher with obesity-related health conditions, such as type 2 diabetes, sleep apnea, or high blood pressure, PCOD.

Bariatric surgery is typically performed laparoscopically, which means that small incisions are made in the abdomen and a laparoscope (a small camera) is used to guide the procedure. This results in less pain, a shorter recovery time, and minimal scarring.

Who can undergo bariatric surgery?

Weight loss surgery isn’t for every overweight person. You should meet certain medical guidelines to qualify for bariatric surgery.

According to American guidelines, bariatric surgery can be offered for you if:

• Body mass index (BMI) is 35 or more
  BMI is 30 or more with other comorbidities like type II diabetes mellitus, Obstructive sleep apnoea, hypertension, and dyslipidaemia
  BMI is 30 or more with uncontrolled diabetes mellitus

According to Asian bariatric and metabolic guidelines, bariatric surgery can be offered for you if:

• BMI above 35 kg/m2 without co-morbidities.
• BMI above 30 kg/m2 with co-morbidities like diabetes mellitus, Obstructive sleep apnoea, hypertension, and dyslipidaemia
• BMI is 27.5or more with uncontrolled diabetes mellitus

How bariatric surgery works?

By changing your stomach and intestine, bariatric procedures affect the production of intestinal hormones that results in hunger suppression and increased feeling of satiety. Hormonal changes after bariatric surgery increase calories burned and increase energy expenditure thus weight loss has higher change for lasting than other methods.

Different types of bariatric surgery.

Roux-en-Y gastric bypass: This is the most commonly performed type of weight loss surgery. During this procedure, the stomach is divided into a small upper pouch and a larger lower pouch. The small intestine is then rerouted to the small upper pouch, which limits the amount of food that can be consumed. This leads to weight loss and improved glucose metabolism.

Sleeve gastrectomy: This procedure involves removing a large portion of the stomach, leaving a smaller, sleeve-shaped stomach. This limits food intake and leads to weight loss and improved glucose metabolism.

One anastomotic/mini-gastric bypass: Anastomotic gastric bypass is a type of weight loss surgery in which the stomach is divided into a smaller upper pouch and a larger lower pouch, and the small intestine is then rerouted to connect to the new upper pouch. This procedure restricts the amount of food that can be eaten and reduces the absorption of calories, leading to significant weight loss.

Duodenal Switch: This surgery involves removing a large portion of the stomach, leaving a smaller stomach pouch. The small intestine is then rerouted to this new pouch, which limits the amount of food that can be consumed. This leads to weight loss and improved glucose metabolism.

How much weight loss after bariatric surgery?

After gastric bypass surgery: Individuals will lose around 75 % of excess weight loss(For an example, Your height is 168cm and weight is 140 kg then your excess weight is 69.44 kg, after rygb, you will lose 75 % of 69.44 kg that is around 51 kg) 1
After sleeve gastrectomy: individuals will lose around 65 % of excess weight loss
After duodenal switch: Individuals will lose around 90 % of excess weight loss
Approx. 90% of individuals are able to maintain more than 50 per cent excess body weight loss after 5 years after bariatric surgery.

What are the side effects of bariatric surgery?

Nutritional deficiencies: Bariatric surgery can lead to deficiencies in certain vitamins and minerals, such as iron, calcium, and vitamin B12.

Gastrointestinal side effects: Some common gastrointestinal side effects include nausea, vomiting, diarrhea, and constipation.

Bowel obstruction: In rare cases, a bowel obstruction can occur as a result of the surgery.

Dumping syndrome: This occurs when food moves too quickly through the stomach and into the small intestine, causing nausea, vomiting, and diarrhea.

Hernias: Hernias can occur at the surgical site and may require additional surgery to repair.

Blood clots: Blood clots can form in the legs or lungs, which can be life-threatening if not treated promptly.

Wound infection: As with any surgery, there is a risk of infection at the surgical site.

Psychological side effects: Some individuals may experience emotional changes, depression or an impact on self-esteem due to their weight loss.

Long-term weight regain: Some individuals may regain weight after surgery if they do not adhere to the recommended diet and exercise regimen.

(It’s important to note that these side effects vary depending on the type of bariatric surgery performed, individual’s health condition and the facility where the surgery was performed. And all these side effects should be discussed with the surgeon prior to the surgery.)

What is the benefit of bariatric surgery?

Significant weight loss: Bariatric surgery can lead to significant and sustained weight loss, often resulting in a reduction of obesity-related health problems.

Improved health: Bariatric surgery can improve or resolve various health conditions such as type 2 diabetes, high blood pressure, sleep apnea, and non-alcoholic fatty liver disease, PCOS.

Increased mobility: Weight loss from bariatric surgery can improve mobility and reduce the risk of injury from falls.

Improved self-esteem: Many individuals report feeling better about themselves and their appearance after weight loss surgery.

Increased life expectancy: Studies have shown that individuals who undergo bariatric surgery have a lower risk of death from obesity-related illnesses.

Quality of life improvement: Bariatric surgery can improve the overall quality of life, including mental health and physical function

Cost effectiveness: Bariatric surgery can be cost-effective in the long term as it can reduce the need for medication and healthcare costs associated with obesity-related illnesses.

Conclusion:

In summary, Bariatric surgery, also known as weight loss surgery, is a type of surgery that is performed on individuals who are severely overweight or obese. The goal of the surgery is to help individuals lose weight and improve their overall health. There are several types of bariatric surgery that can be performed, such as Roux-en-Y Gastric Bypass, Sleeve Gastrectomy, Biliopancreatic Diversion with Duodenal Switch (BPD/DS) . After surgery, patients are required to follow a strict diet and exercise program and work closely with a team of healthcare professionals.

References:

Pories WJ. Bariatric surgery: risks and rewards. J Clin Endocrinol Metab. 2008;93(11 Suppl 1):S89‐S96. doi:10.1210/jc.2008-1641