Bariatric surgery for a longer, better life

Overweight and obesity are a huge problem worldwide. Apart from the physical problems that obesity brings with it, there are a number of medical problems that occur which lead to decrease in quality of life and ultimately reduced our lifespan. In fact, the WHO has officially classified obesity as a disease.

What we need to understand is that our weight is controlled by our hormones, which is why most people maintain the same weight for years. People who are affected by this disease have a genetic propensity for obesity.

Then there are environmental triggers like stress, disordered sleep or untimely meals, pregnancy, ageing and many drugs or medicines which act upon the patient and cause weight gain. Once weight gain happens, the fat cells itself act like a hormone-secreting organ and sustain obesity.

Once we understand that obesity is a result of hormonal disturbances, we will realise that reducing weight is not a simple arithmetic of calories in and calories out. It is true that diet modification, exercise and medicines can help in weight reduction but the total weight loss is usually only 10-15%. For somebody who is only 10-15 kg overweight this is more than enough.

But for someone who needs to lose around 40-50 kgs, an external intervention like bariatric surgery is necessary as hormonal disturbances are more in such patients.

The other thing that to understand is that obesity gives rise to many other medical problems. The main diseases that are a direct result of obesity and hormonal disturbances are Type 2 diabetes mellitus, high cholesterol, high BP, sleep apnea, excessive snoring, fatty liver and later on cirrhosis, PCOD and infertility, knee and back problems.

When obesity is treated, these diseases come under check and in a majority of the patients, disappear. Diabetes is one big example.

Diabetes disappears in a majority of obese patients who are treated with bariatric surgery. In fact, the need for medicines and insulin to control blood sugar goes down in the first few days after surgery. Even before significant weight loss occurs and in appropriate patients, the benefit is long lasting - more than 10-15 years.

There is a large body of research which has shown that to achieve considerable control over diabetes, bariatric surgery is better than optimum medical treatment and intensive lifestyle modification under professional supervision.

Similarly, sleep apnea or OSA is completely cured in 95% of patients after bariatric surgery. Most patients see improvement in a week after the operation. Likewise, high BP, high cholesterol, PCOD and all other problems experience improvement after surgery and the effect is sustained.

Safe procedure

It is believed that this surgery is extremely complex. Well, any operation carries a certain amount of risk, no matter how small it is. Part of the risk is related to anaesthesia, mostly due to the patient's weight and other medical problems like diabetes, sleep apnea etc and the other is related to the operation itself.

Bariatric surgery, if conducted in a well-equipped centre by a good surgeon is extremely safe. In fact, patients who have diabetes or sleep apnea due to obesity are the ones who need this operation the most and they are the ones who will gain the best results.

In conclusion, it is important to understand that obesity is not a self-afflicted condition and the affected person is not to be blamed - it is a complex disease caused due to hormonal imbalance.

Mild overweight and obesity can be effectively managed with diet and lifestyle modifications alone if maintained for a long period of time, whereas, severe obesity, especially with other diseases like diabetes, OSA, high BP, PCOD etc. is more effectively managed with bariatric surgery.

Scientific bodies dealing with guidelines about treating diabetes now recommend that bariatric surgery should be considered early for the treatment of the condition in appropriate patients because it gives better results than lifestyle changes and medication.

Effective treatment of obesity through bariatric surgery leads to improvement in all these diseases, often even before there is sizable weight loss. This leads to massive improvement in the quality of life and in the long term, an increase in the lifespan by 5-10 years.

(The writer is Chairman, Bariatric Division, Manipal Hospitals)

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