Twenty three year old Manish, with a strong family history of obesity, started suffering very early in life and got into a vicious circle of weight, poor self-esteem and depression with comfort eating and progressive weight gain. He had been trying to lose weight over 2 years with dieting and exercise but after losing 10-12 kg, when things would stall, he would give up, which became a constant source of frustration for him.

Later, on clinical advice, he underwent bariatric surgery and lost 15 kg in one month and was able to follow the recommended diet due to reduced hunger easily. Manish started exercising vigorously within a month of surgery and took things to the next level with self-encouragement and within one year, he lost 60 kg weight going from 150 kg to 90 kg and gained significant muscle mass.

Exercise became his new passion, so much so that it really helped him follow a very strict diet almost excluding carbohydrates! This one of the successful cases underlines the importance of bariatric in the present scenario.

In an interview with HT Lifestyle, Dr Vikas Singhal, Associate Director, GI Surgery, GI Oncology and Bariatric Surgery at Medanta in Gurugram, shared, “Weight loss surgery, Bariatric, or Metabolic surgery are several terms used interchangeably for treating patients suffering from obesity and its health complications. The surgery has become very common and can be truly life-changing for patients. This surgery is a weight-loss procedure that alters the digestive system to aid weight loss. It is often performed when diet and exercise have not been effective or when serious health issues arise due to weight. Some procedures limit dietary intake, while others reduce fat and calorie absorption.”

An affirmative approach is needed

Dr Vikas Singhal revealed, “A change in perception about obesity is the first effective step to deal with this pandemic. There is a pressing need to understand that obesity is a “disease” and not just a cosmetic problem. Someone thinking about the surgery needs to understand the changes in lifestyle that come with the surgery and the things one is required to follow. Secondly, it is really important to know that bariatric is not a cosmetic procedure where some body fat will be removed. This surgery “resets” the GI system of the body.”

He added, “In fact, it is a procedure where the effectiveness of the surgery is user-dependant. Someone can really take great help from the procedure and put it to great benefit for themselves by following the diet and exercise recommendations and lose most of their excess weight and get rid of diabetes, high blood pressure, stroke and several cancers. The surgery can greatly improve not only physical but also mental health.”

Types of bariatric surgery

According to Dr Vikas Singhal, there are different types of Bariatric surgeries which are all generally done either Laparoscopically or with Robotic assistance. He explained, “The surgery works in several ways, including restricting the diet, decreasing the absorption of food and, most importantly, the metabolic or hormonal changes that happen with the surgery. Common types of bariatric surgery include Roux-en-Y gastric bypass, sleeve gastrectomy, biliopancreatic diversion with duodenal switch (BPD/DS), and single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S).”

Dr Vikas Singhal elaborated, “Roux-en-Y gastric bypass is the most common method, and it is typically not reversible. It works by cutting across the top of the stomach, sealing it off from the rest of the stomach and sewing part of the small intestine onto the pouch. Sleeve gastrectomy removes about 80% of the stomach, leaving a long, tube-like pouch that can hold less food and produce less of the appetite-regulating hormone ghrelin. Advantages of this procedure include significant weight loss, no rerouting of the intestines, and a shorter hospital stay. In addition, biliopancreatic diversion with a duodenal switch is a two-part surgery that limits eating and reduces nutrient absorption.”

So who is the surgery really for?

Dr Vikas Singhal informed, “Bariatric surgery requires specific criteria based on universal standards. These include a body weight greater than 45 kg, a BMI greater than 37 or 32 with medical complications related to obesity, a documented history of weight management and weight loss attempts, and no indication of active alcoholism, active drug addiction, or a major psychiatric disorder. Other criteria, such as age and general health, are also evaluated. After determining the appropriateness of surgery, a nutritional evaluation is conducted, and support structures may be established.”

He concluded, “In some cases, a different type of surgery or alternative treatment may be recommended. Bariatric surgeries can lead to long-term weight loss, addressing conditions like heart disease, high blood pressure, cholesterol, sleep apnea, Type 2 diabetes, osteoarthritis, joint pain, and skin conditions. They improve daily activities and quality of life but permanent diet and exercise changes are crucial for long-term success. In most cases, bariatric surgery reduces life-threatening health issues.”

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