Myths about bariatric surgery................
Dr Abhishek Katakwar (MS, FIAGES, DMAS (Germany), FMBS(Taiwan))
Laparoscopic Bariatric and Metabolic surgeon
Asian institute of Gastroenterology, Somajiguda, Hyderabad
Myth: Bariatric surgery is a quick and easy fix for rapid weight loss.
Reality: Surgery for weight reduction is not a miracle procedure. Weight loss surgery is designed to assist the morbidly obese in developing a healthier lifestyle. A surgical weight loss operation is a useful tool for weight loss, but it is a surgical procedure that requires a substantial lifelong commitment. The surgery alone will not help someone lose weight and keep it off. The patient must change eating and exercise habits. Without changes to the daily pattern of eating and activity, the patient is likely to regain the weight over time. You’ll need to attend educational classes and support groups to work on developing new, lifelong healthy habits and behaviors. Above all, you’ll need to maintain a commitment to reach and maintain a weight that keeps you healthy.
Myth: All bariatric surgery involves “stomach stapling.”
Reality: There are many different types of gastrointestinal procedures for weight loss, some of which reduce the functioning size of the stomach and others that bypass parts of the digestive tract, reducing absorption of calories and nutrients. Different types of surgeries offer different results, and some are more suitable for particular people than others.
Myth: Obese and morbidly obese people are lazy and stupid.
Reality: Obese and morbidly obese people suffer from a disease called obesity. Most have tried numerous ways to lose weight and get healthy, but were unsuccessful. Weight loss surgery is usually a last resort, but a necessary option. Unfortunately many obese people suffer discrimination and unwarranted scrutiny and judgment due to their excess weight.
Myth: Bariatric surgery is extremely dangerous.
Reality: Any type of surgery has associated risks, such as complications or even death. But a number of recent advances have helped to minimize risks. Surgeries performed at Asian institute of gastroenterology are done laparoscopically with mini-incisions that result in faster healing, less pain, and less scarring. In addition, having the procedure may assist patients in overcoming otherwise life-threatening conditions associated with obesity, including Type II diabetes, hypertension, high cholesterol and sleep apnea.
Myth: If I have had previous surgeries, I am not a candidate for laparoscopic surgery.
Reality: You are still a candidate for laparoscopic surgery even if you have had prior “open” surgeries or other minimally invasive surgeries. Of course each individual case is different and a proper evaluation is needed.
Myth: Certain surgical weight loss operations prevent proper nutrition.
Reality: It is true that most patients must take supplements after certain weight loss operations because the procedure inhibits proper absorption of vitamins and minerals. However, patients who follow their doctor’s advice about meal planning can enjoy a nutritionally balanced diet. In many cases, their overall health and well-being is dramatically improved after the operation.
Myth: Follow up care is not necessary.
Reality: To be the most successful follow-up care for at least one year is critical. Patients usually meet two to four times with a health care team member. Team members work to help patients make long-term lifestyle changes.
Myth: You must weigh over 100 Kg to qualify.
Reality: It’s not just about your weight. Your health conditions are also a big factor. Numerous recent studies have shown that even moderately obese individuals who have significant health issues can show marked health improvements after undergoing weight loss surgery. There are guidelines for weight-loss surgery, set by the ACMOMS (2009) for Indian population. However, it's not just based on weight alone but on what other medical conditions you also have, such as diabetes.
BMI > 35 kg/m2 with or without comorbities
BMI > 32 kg/m2 with comorbities
BMI > 30 kg/m2 with central obesity WS > 80cm (females) WS > 90 cm (males) with at least two criteria of metabolic syndrome
Raised TG (>150 mg/dL )
Reduced HDL (< 40 mg/dL )
Hypertension (>130/>85 )
Raised FBS (> 100mg/dL )
BMI >27.5 kg/m2 with inadequately controlled DM (HbA1c >7)
*BMI = Weight in KG/(Height in meters)2
Myth: Insurance does not pay for bariatric surgery.
Reality: Unfortunately Insurance coverage for weight loss surgery is not widely included in India, but many companies provide Zero percentage EMI loan for bariatric surgery. If you are considering weight loss surgery, the first step is to contact your bariatric surgeon to find out if the procedure is covered and what, if any, exceptions may exist. One important point to keep in mind is that obesity and morbid obesity are considered two different health conditions. Many plans will exclude treatment for obesity but will cover treatment for morbid obesity.
Myth: Weight gain after a bariatric surgery is due to the stomach/pouch stretching back out.
Reality: obesity is a life style disorder so even after surgery patient has to follow diet plan do exercise. Many a patient does not follow with their surgeon and gain weight. If patient does not follow instruction than yes there is dilatation of stomach or pouch leading to weight regain.
Myth: You need to have advanced, serious health conditions to qualify.
Reality: Every candidate for weight loss surgery must be assessed based on his or her specific health conditions and Body Mass Index. It is widely agreed that anyone with a BMI over 40 qualifies, even if they do not have significant health problems. Individuals with a BMI over 35, plus one or more obesity-related health conditions are considered candidates for surgery.
Myth: There is a long recovery time after weight loss surgery.
Reality: Most people recover from weight loss surgery within one to two weeks. Some patients are able to return to work and their normal activities within just a few days.
Myth: After surgery, you won’t be able to eat anything good.
Reality: Most people can eat a wide variety of all kinds of foods. Some patients who’ve had Gastric Bypass Surgery experience an unpleasant sensation when they eat very sweet foods. However, most people can eat just about any kind of food in small quantities. Our ultimate aim is to educate patient to choose right and healthy food.
Myth: You have to be a certain age to have surgery.
Reality: While most surgical weight loss centers include age as a criterion, the ages of the patients they treat often cover a wide range, from 18 to over 65.But in certain circumstances lower age limit could be up to 14 years.
Myth: You can’t have surgery if you have diabetes.
Reality: Weight loss surgery is becoming a primary treatment for diabetes, especially for patients with Type II Diabetes, because of the high rate of cure after surgery.
Myth: Weight loss surgery helps people shed those extra 20 kilos.
Reality: Many people don’t realise that gastric banding, sleeve gastrectomy and gastric bypass are not cosmetic procedures to be taken as lightly or performed as frequently as Botox or a nose job. Weight loss surgery is a definitive and final step for people weighing at least 40Kgs over their ideal body weight. These people have a BMI of 32.5 to 37 or higher, and have unsuccessfully tried many a fad diets, taken so called “weight reducing pills” and attempted other means of weight loss. There is consideration, conversation and qualification before a procedure. After the operation, patients must keep to a rigorous follow-up schedule. People who are 10-15 kilos overweight have a host of tools and approaches available to them that can assist them in regaining health, managing their appetite and keeping weight off.
Myth: Obese people have to undergo surgery because they are lazy.
Reality: On a personal level, this misperception annoys me the most. By the time these people come to my outpatient clinic, they have tried every diet available. They have suffered immense social, emotional and psychological stress, and they want nothing more than to rid themselves of the excess body weight they carry. Due to an individualized interplay among genetics, environment and behavior, these patients have realised that their best chance of living a normal life is to resort to a band, sleeve or bypass.
Myth: It’s Dangerous!
Reality: As part of my job, I literally get inside of people and either reroute their digestive tracts or slip a lap band over the top of their stomachs. Sounds dangerous, right? As with any surgery, weight loss surgery carries risks. But modern technology has made bariatric procedures relatively safer. In a study of 66,000 obese people over five years, those who chose to have a bariatric surgery lived longer than those who did nothing. It has been shown repeatedly that it’s far more dangerous to live life morbidly obese than to undergo a bariatric procedure. I’ll put it in perspective: In most programmes, the risk of a bariatric surgery is in line with the risk of having one’s gallbladder removed.
Myth: You’ll never be able to enjoy a real meal again OR Now you can eat everything you want!
Reality: Patients who undergo bariatric surgery can, in fact, celebrate their birthday with a little cake, they just can’t eat the whole thing anymore! People learn new, reasonable, healthy eating behaviors. Trying to eat too much at one time would make it hard to keep the food down. With those caveats, a person can live an unrestricted life following surgery. They can go out to restaurants, take a cooking class and host a family dinner!
Myth: Bariatric patients undergoing surgery have a very restricted lifestyle.
Reality: Bariatric surgery has a significant impact on the patient’s personal life. Men and women who are morbidly obese deal every single day with deep, core issues of self-esteem and pride. For example, there are physical repercussions of being so overweight (like, inability to control the bladder) that can be embarrassing, if not humiliating. Bariatric surgery can help restore dignity. About sixty percent of my patients are women. Many obese women have suffered not only emotional abuse because of their weight, but actual physical abuse as well, perpetrated by our society that didn’t respect them and convinced them that they were unworthy of love and affection. Dramatic weight loss over time often brings these women a new self-confidence and a new beginning to a more fruitful life.
Myth: What is the difference between bariatric & metabolic surgery?
Reality: Though, there is a large amount of overlapping between Bariatric and Metabolic surgery, however, all Bariatric procedures can also be called Metabolic procedures because the word metabolic says that it changes your metabolism. So, what happens in a Bariatric surgery? It can be divided primarily into three limbs— One, Surgery done for morbidly obese patients who do not have any associated co-morbidities such as diabetes, hypertension, etc. The second limb would consist of patients who have obesity which is related with diabetes, and other co-morbidities like hypertension, heart problems, kidney problems, etc. And the third limb would consist of patients who have diabetes only, without any associated obesity. So Bariatric surgery is primarily done for patients who are obese or have related diseases like diabetes and hypertension. Whereas, metabolic surgery for diabetics would encompass purely surgery done for patients with diabetes without associated obesity.
Myth: All Diabetic patients should go under the knife and get the surgery done?
Reality: Absolutely NOT! There have been strict guidelines and criteria to choose a patient who would benefit from this surgery. So, based on individual cases, we decide which patient will benefit from it. However, broadly speaking, patients who have Diabetes for less than a duration of 10 years, have good C-peptide levels, good pancreatic function, or those who have not been Insulin dependent for a long time or those who do not have involvement of more than 2 organs have a much better chance of getting a resolution in terms of Diabetes. But an individual study of cases can speak best.