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 weight over time. You’ll need to attend educational classes and support groups to work on developing new, lifelong healthy habits and behaviours. Above all, you’ll need to maintain a commitment to reach and maintain a weight that keeps you healthy.
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 the absorption of calories and nutrients. Different types of surgeries offer different results, and some are more suitable for particular people than others.
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 the last resort, but a necessary option. Unfortunately, many obese people suffer discrimination and unwarranted scrutiny and judgment due to their excess weight.
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 the 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.
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.
Reality: It is true that most patients must take supplements after certain weight loss operations because the procedure inhibits the 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 are dramatically improved after the operation.
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.
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 the 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 comorbidities
BMI > 32 kg/m2 with comorbidities
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 ) Increased LDL 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
Reality: Unfortunately Insurance coverage for weight loss surgery is not widely included in India, but many companies provide Zero percentage EMI loans 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.
Reality: obesity is a lifestyle disorder so even after surgery patient has to follow a diet plan to exercise. Many a patient does not follow with their surgeon and gain weight. If the patient does not follow instructions then yes there is dilatation of the stomach or pouch leading to weight regain.
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.
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.
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 the patient to choose the right and healthy food.
Reality: While most surgical weight loss centres 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, the lower age limit could be up to 14 years.
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.
Reality: This is not true. However, it is true that you will be on a liquid diet for a short period of time. Before you have weight loss surgery your doctor will put you on a liquid diet for approximately two weeks. This allows your liver to shrink and makes the surgery easier to undertake. You will then be on a liquid diet for approximately 1-2 weeks post-surgery and then transitioned into a regular solid food diet.
Reality: A few decades ago this may have been true, due to the type of surgery that was performed. However, the majority of weight loss surgeries are now carried out laparoscopically, meaning you will be left with a very small mark. “Lap-Band, gastric bypass and sleeve gastrectomy are performed via a laparoscopic technique,” says Dr Abhishek Katakwar, Asian Institute of Gastroenterology’s bariatric surgeon. “The laparoscopic technique is a minimally invasive way that a surgeon can perform complex procedures that used to require the conventional large incisions.”
Reality: It is possible to have children after weight loss surgery. However, most doctors will advise you to wait at least one year before trying to get pregnant. This is because you need to wait until you have lost a large proportion of what you wanted to lose and your weight loss has stabilized. After weight loss surgery your hormones will be changing and your body will be nutritionally depleted until you stabilize your daily vitamin intake. This is because the operation inhibits the absorption of vitamins and minerals. All of these things can affect getting pregnant and are the main reasons why your doctor will advise you to wait. In fact weight loss can resolve problems related to polycystic ovaries improving fertility. Patients are much less at risk during pregnancy because their other health problems have lessened or disappeared. After your weight is back to normal and assuming you don’t have any other health problems, you can expect to have a normal delivery.
Reality: Dumping syndrome, although common after weight loss surgery, is not experienced by everyone. Some people don’t “dump” at all, some occasionally and some extensively. “Dumping syndrome is commonly caused by the rapid entry of undigested food products from the stomach into the small bowel where your body is not prepared for the concentration and rushes to dilute it by “dumping” fluid and electrolytes rapidly into the contents of the intestines,” says Dr D.N. Reddy, Gastroenterologist from Asian Institute of Gastroenterology. “Avoiding excessively fatty foods, or high sugar simple carbohydrate meals in small portions may help to ease the symptoms.”
Reality: Insurance companies use the guidelines when considering whether or not to support weight loss surgery. However, it is not all based on weight alone. If you have other risk factors that your obesity is causing, adding to or affecting, it may be possible to use this as supporting evidence for your insurance claim. Every insurance company works to different guidelines, so you should always check with your insurance company first.
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 fad diets, taken so-called “weight reducing pills” and attempted other means of weight loss. There is a 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.
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 behaviour, these patients have realised that their best chance of living a normal life is to resort to a band, sleeve or bypass.
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.
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 behaviours. 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!
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.
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 is 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 to 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.
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.
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