Dr. M G Bhat is one of the well-known laparoscopic surgeons in Bangalore, India. His field of interest includes bariatric surgery, pancreatic surgery and laparoscopy surgery. He offers weight loss treatment in Bangalore.
Obesity is a silent killer. Those extra kilos of flab you are carrying around could even prove fatal in some cases. It has been scientifically proved that obesity can lead to diabetes, heart disease, and at times to certain types of cancer. But that is not all.
Obesity affects every part of your body – from your head to toe. And in some cases, it causes depression and social stigmatization. It also puts you at a risk of high blood pressure, gallbladder diseases, osteoarthritis, and breathing problems – including sleep apnea (when a person stops breathing for a short time during sleep) and asthma.
Effects on the heart
An ‘apple-shaped’ body is more prone to health issues than a ‘pear-shaped’ body. The extra weight you accumulate around your tummy leads to high blood pressure and high cholesterol levels, which in turn increases the risks of a heart disease. Being obese puts you at a high risk for a congestive heart failure – where the heart is unable to pump sufficiently to maintain blood flow to meet the body’s needs.
Obesity may trigger the risk of cancer in certain cases. This is because obese people often have chronic low-level inflammation which can cause damage to the DNA making the cells multiply abnormally. The fat tissue also produces excess hormones, which raises the risk of breast, ovarian, colon, kidney and cancers affecting the esophagus.
In addition to all this, obesity also affects the reproductive system, the nervous system, and the skin. Hirsutism – the case of excess hair growth especially in women is linked to obesity. It also triggers fatty liver, low back pain, erectile dysfunction, and dementia.
The worst about obesity is that it can affect every part of your body in ways you may even imagine.
However, the best fact about obesity is that many diseases that stem from it can be reversed by a simple change in your lifestyle or through medication and surgery.
Gastric bypass surgery is a sure shot way for losing weight. This surgical procedure creates a small upper stomach pouch and reroutes the intestines thereby making you feel fuller faster. There are cases where people have lost up to 67 % of their excess weight within a short span of time after this procedure.
The gastric bypass surgery is done under anesthesia. The surgeon creates a small upper stomach pouch bypassing a major portion of your stomach. The procedure for creating this small pouch is also known as ‘stomach stapling.’ The food is then re-routed through portions of the small intestines curbing your absorption of calories and nutrients. This surgery is restrictive since the newly created pouch can hold only a small amount of food.
What is the effect?
Since the surgery makes the stomach size smaller, you feel fuller fast. The flip side is that after this surgery you absorb fewer minerals. And since you cannot hold a lot of food, you will not eat unhealthy food. Experts say that many people have lost up to 67% of their excess weight after this surgery.
Who should go in for it?
If your Body Mass Index is above a limit and none of the methods to lose weight works over time, you can consider this surgery. It is irreversible and should be considered only after consultations with a doctor. It will need hospitalization for up to three days and a recovery time of 4 to 6 weeks.
This is a major surgery and extreme care is needed over a prolonged period of time. Deep vein thrombosis or the possibility of blood clots forming in your body is one of the major risks in the first six weeks after the procedure. There are cases where small leakages have been reported in the stomach and intestines. Nausea, vomiting, and diarrhea are also reported in certain cases.
After the surgery
Since it is a restrictive surgery, you will not be able to eat large meals. Too much of sugar and carbs will make you sick and you will not absorb all the calories that you eat. In the long run, the hormones will adjust from the rapid weight loss and your metabolism will improve. Once you lose weight, it becomes easier for you to stick to regular exercise and along with a healthy diet stick to an ideal weight.Even though newer techniques are in vogue now, gastric bypass remains the ‘gold standard’ for weight loss surgery. This, is perhaps why it is the most preferred bariatric surgery method.
You might be anxious to get back to duties at work or at home. You must understand that your body has undergone a major change, and it is realigning itself to this new, positive change. You must give yourself time to allow that change to work.
After bariatric surgery, most patients can return to normal routine after 2-3 weeks. However, all activity may have to be cut down in half initially, as your body is still recovering.
Each type of surgery will have a different recuperation time, as the procedure, incisions, and the new digestive routes are different. Patients who undergo open surgery will take longer to recover than patients who undergo laparascopic surgery. This is because open surgery involved one large incision usually in the abdomen. This will take longer to heal. Laparascopic surgery uses 5-6 small incisions. This reduces healing time.
Lab band method has a shorter hospital stay, whereas the others might need more. Hospital stay is typically, 1 day for gastric band (lap band) and 2-3 days for gastric sleeve, gastric bypass and duodenal switch.
With lap band technique you can return to normal activity in around a week, while the other methods might need you to rest for 2-3 weeks before you can return to your routine. All this depends on advisement from your surgeons, as your response to the surgery is being gauged by them. You may be asked to avoid strenuous activities such as lifting heavy loads and working out at the gym.
In general, patients make a full recovery from anywhere between 1 to 6 weeks, depending on the procedure and the patient. The gastric band method allows you to make full recovery in around 1 week. Other surgeries require a full recovery time of around 4-6 weeks.
You will transition from clear liquids to solid foods, pain will gradually cease and can be managed with prescribed medication. You will be asked to perform mild to moderate activity. Speak to your doctor about an appropriate gym routine and when you can start.
The new restricted diet with small portions and liquid foods will leave you with lower energy levels. Added to this is the strain of a surgical procedure and the mental adjustment to settle down into a new diet and activity patterns.
You will be given clear instructions by your medical care team regarding what you can and cannot do. Based on this, you can arrange your daily routine at work or at home with support from others. For example, you might want to work half days initially and build up to full work days. Or you might want to delegate getting groceries or picking up the laundry to a family member.
By sticking to the recovery plan, you will heal well and lose weight. This will improve your health — physical and mental. The benefits of bariatric surgery will boost your productivity and the overall quality of life. Make your decision based on advice from a qualified and experienced surgeon.
Done with the right experts — qualified and experienced to perform these procedures
Done with the right aftercare programme — diet, physical activity and medication, if any.
Done with the right patient — dedicated to the weight-loss programme.
To assess which procedure suits you best, various factors are considered — Health condition, BMI, aversion to foreign bodies, aversion to risk, influential behavioural characteristics, personal preferences, etc.
BMI is a factor that affects the results of weight loss surgery. The heavier you weigh the more weight lose and faster. Bariatric surgery is usually performed on persons with a Body Mass Index of 40, or a body Mass Index of 35 with co-morbidities like heart diseases, diabetes, metabolic disorder, etc. Biliopancreatic diversion (with duodenal switch) is performed on super obese persons (BMI of 50 or higher).
How much do you need to lose? Each surgery provides different range of outcomes. Gastric bypass patients lose 70% of their excess weight, gastric sleeve patients lose 60% of their weight, and gastric band patients lose 50% of their weight on average. For example, gastric bypass surgery shows faster weight loss in the first year than gastric sleeve procedure. But in three years post-surgery, the weight loss from both procedures starts to match.
Health conditions affect the choice of procedure. If you have GERD, your surgeon may suggest gastric bypass over gastric sleeve.
Patients who have poorer control overeating patterns might choose the banding procedure as it is reversible. Whereas gastric bypass is typically not. It can be reversed, but it is a challenge. Gastric sleeve is cannot be reversed. However, such patients who choose gastric bypass will be advised that they will experience ‘dumping’ if they consume food that contain excess sugar. It is a kind of negative reinforcement or a checking mechanism that will discourage the patient from inappropriate eating habits.
Gastric bypass is more invasive than gastric sleeve. Hence, gastric sleeve may be recommended to a person who is more ill or averse to risks. Gastric sleeve patient can later chose to undergo gastric bypass as the next step. Persons who have a real fear of needles might have difficulty with gastric banding technique at it involves injecting saline into the lap band to tighten it. This needs to be done multiple times in the first year and fewer injections every year after.
Procedural time, however small a factor, is certainly to be considered. The risk of going under anaesthesia is higher for obese persons. More so, for persons with co-morbidities. Discuss procedural duration with your surgeon and assess your risks.
How fast you want to realise your goals is factor to consider. Gastric bypass surgery produces results in the first year and then slows down. Gastric sleeve procedure sees weight loss over a period or 2-3 years. Outcomes such as loose skin is inevitable with major weight-loss — more with quicker weight loss (gastric bypass), less with slower weight-loss over longer periods (gastric sleeve). The significant boost to health far outweighs the cosmetic outcome of loose skin.
Speak to your surgeon about your weight-loss goals and concerns, current challenges to lose weight, failed attempts at weight loss and why, eating behaviour, how obesity is an obstacle to the quality of life. Choosing the appropriate weight-loss surgery should be only upon the advice of a qualified surgeon. And always remember that drastic measures like weight-loss surgeries are to be resorted to only when traditional approaches to weight loss through diet and exercise over a prolonged period fail.
Bariatric surgery is a general term used to refer to various kinds of weight-loss surgeries that facilitate weight-loss through food restriction, malabsorption of calories or both in morbidly obese individuals.
Weight loss begins with the surgery. The changes that the surgery brings about and the adherence to the strict diet, activity and medication plans designed for each patient is what determines the range of weight loss.
Before we have a look at the long-term risks it is important to understand the long-term benefits
Long term benefits include more than just the weight loss involved. Bariatric surgery reduces mortality from cancer (by 60%), coronary heart disease (56%), and Type 2 Diabetes (92%) according to the American Society for Metabolic and Bariatric Surgery (ASMBS). It improves or treats more than 40 obesity related health issues. Health care costs are reduced over the years after surgery, which is also due to the reduction or resolution of obesity related health conditions. Added to this are improved quality of life, improved mobility and self-image of the patient.
Laparoscopic surgery now offers less invasive surgical procedures with smaller, faster healing wounds, lesser post-operative pain and better post-operative pulmonary function. However, there are risks involved as with any major surgery. Anastomotic stricture, gastrointestinal bleeding or late postoperative bowel obstruction may be seen.
Development of gallstones, hernias, bowel obstruction, dumping syndrome (nausea, vomiting, diarrhoea), hypoglycemia (low blood sugar), malnutrition (if supplements have not been taken regularly), ulcers, stomach perforation, leakage along surgical wounds are various risks associated with different bariatric surgeries.
In the case of the lap band technique, the risks are of a unique type not seen in other methods due to the involvement of the band. Tube or port malfunction requiring reoperation, erosion of the band, pouch dilation or band slippage are the risks involved in gastric band method.
Dumping syndrome is seen in some persons after gastric bypass surgery, when food with excess sugar or excess amount of food is passed directly into the intestine, patients might feel nausea, dizziness or cramps.
In some cases, hypoglycemia might develop when the body produces insulin, but not enough blood glucose. Slow-release carbohydrates and proteins can help combat this. Since the usable stomach is small, the amount of food the patient can contain is restricted. Hence, getting the balance right will be a challenge.
Fecal incontinence is a factor that is not commonly discussed. This can be emotionally disturbing for some. This probably develops as a part of dumping or because the patient might have had an underlying incontinence issue prior to surgery.
Gallstones might develop in some due to fast or significant weightloss. Obese persons produce more cholesterol than normal, and sometime the gall bladder does not function the way it should.
In restrictive and malabsorptive procedures, the patient can contain only small amounts of food to begin with. Added to this, the caloric and nutrient absorption is limited. They must take nutrient rich and protein packed food in order to avoid malnutrition and osteoporosis.
Any kind of major surgery carries risk, and bariatric surgery is no exception. The health risks associated with obesity far outweigh the risks associated with bariatric surgery.
Bariatric surgery brings about changes in the patient’s life that influence the person’s health, self-image and relationships. Quality of life and longevity is improved after bariatric surgery when compared to morbidly obese persons who do not undergo bariatric surgery.
What is essential is an open and transparent channel between the patient and the doctor. The health condition of the candidate for surgery will be assessed in depth and the patient will be informed about all aspects of the surgery. With all the information provided, the patients will be well informed about the risks and actual benefits associated with the surgery. Surgeons advise whether bariatric surgery will be appropriate for you. Not all obese patients qualify to undergo bariatric surgery. Before initiating the weight loss programme, doctors assess the risk factor profile of the patient and counsel accordingly.
There are various types of bariatric surgery and each type of surgery carries different risks and benefits. Your surgeon will consider your health history, BMI, eating habits, obesity-related health risks and your various test results to suggest the type of weight-loss surgery that will be best for you.
What are the real risks?
All surgeries present risks and these risks vary with the patient and their health condition.
Post-surgery only about 10% of patients have complications, which are minor. These include:
Only 1% to 5% of patients have any serious or life-threatening complications. These include:
Pulmonary embolism (blood clot)
Serious infections and/or bleeding
Mortality after bariatric surgery is found to be a rare event (Morino M et al.). Mortality rates of bariatric surgery compare favourably to that of other major surgeries (Buchwald et al.). More recent studies reaffirm that mortality associated with bariatric surgery is low, as low as 0.08%-0.35% (Su-Hsin Chang et al.). It can be inferred that the risk of dying from an obesity-related health condition is greater.
After weight-loss surgery, your body may not absorb enough nutrients from the food you consume. You may be required to take supplements as suggested by your doctor. Regular blood tests will allow you to monitor your health status.
Why bariatric surgery?
Obesity is a very real concern. It brings with it conditions that affect the way the patient leads his life. Some of the major and glaring health conditions are diabetes, cardiovascular disease, dyslipidema, metabolic disorders, hypertension, non-alcoholic fatty liver disease, GERD, PCOS, sleep apnea, urinary incontinence, impotence, depression, migraine. The co-morbidities of obesity are responsible for millions of deaths worldwide.
There is no question that a good diet plan and physical activity will not only impart a healthier life, but will also ward off several diseases. However, traditional weight loss approaches often fail in morbidly obese individuals. That is when bariatric surgery can help, if it is appropriate for you. It is an option to be explored only when all other weight-loss interventions have failed.
The decision to opt for weight-loss surgery is a major step. It requires thorough assessment, careful thought and consideration. As a facility that is dedicated to help you realise your weight loss goal, we have highly experienced surgeons who have successfully overseen many bariatric procedures. We perform thousands of surgeries every year and are well-equipped to facilitate your wellness. We can assure you that you are in good hands!
Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder in women, which happens due to the imbalance between estrogen and progesterone. Benign ovarian cysts develop around the ovaries. PCOS can affect menstrual cycle, fertility and physical appearance. But that’s not all.
If it is not treated well in time, PCOS will lead to diabetes and heart disease. Dyslipidema and hypertension are also seen. PCOS can influence lipid levels (triglycerides, cholesterol), and hence, the cardiac function. Studies suggest that the risk of cardiovascular diseases in PCOS women is higher than that in normal population. PCOS affected persons show insulin resistance, i.e., difficulty using insulin. This will increase blood glucose levels, increasing the risk of diabetes mellitus. Obesity is seen to be quite common in women affected by PCOS. Obesity and PCOS are inextricably related. Increased blood sugar levels, higher triglyceride levels, obesity can lead to metabolic abnormalities.
There is evidence of atherosclerosis by abnormal carotid intima-media thickness measurements in PCOS women. Intima-Media Thickness (IMT) is an indicator of atherosclerosis. In a study, lipid profiles, blood pressure, waist circumference, Body Mass Index and IMT of carotid artery were measured in PCOS patients. It was seen that women with PCOS have a greater carotid IMT and plaque and this is probably due to the adverse metabolic profile seen in PCOS.
How can PCOS be managed?
Women with PCOS will benefit from losing weight. This will help balance hormone levels and set the menstrual cycle right. The most common and first step in this direction is to monitor diet and introduce or increase physical activity.
However, dietary changes and physical activity undergone to control PCOS symptoms in women with morbid obesity, sometimes brings about only moderate weight loss, and, sometimes this weight is regained. This leads to treatment with oral contraceptives and insulin sensitizers. In most cases, unfortunately, the painful, discomforting and depressing symptoms of PCOS remain.
How does Bariatric Surgery help?
Bariatric surgery can help women with PCOS. After bariatric surgery, along with the obvious weight-loss results, blood sugar levels go down, related heart conditions improve, metabolic abnormalities are reduced. The weight reduction helps restore normal menstrual cycles and ovulation. Fertility improves.
PCOS women produce more androgens than normal and this extra androgen in the body leads to acne, hirutism, deeper voice, etc. Patients see an improvement in hirutism after surgery.
HbA1C also improved post-operatively within 3 months. Improvement in insulin resistance and associated metabolic disorders indicates how bariatric surgery helps PCOS women. The metabolic, hyperandrogenic and reproductive manifestations of this disorder in obese women can be managed efficiently through bariatric surgery.
Thought and consideration
Serious consideration is required before opting for surgical intervention to treat obesity, PCOS, diabetes or other morbidities. It is not a quick fix and calls for major changes in your life, apart from just dietary and lifestyle changes. Bariatric surgery does not guarantee resolving infertility issues or a cure for PCOS. However, if your medical condition has been assessed well by your doctor and you qualify for bariatric surgery, understand that bariatric surgery can help you control the severity of PCOS.
The decision to go for a bariatric surgery is not simple. We understand the experiences and considerations that you have thought over. You have probably debated the pros and cons of the procedure, just as you would with any surgery.
Once you have made the decision and have consulted your medical expert to know if the procedure is right for you, it is necessary to prepare your mind and body for what lies ahead.
While physical preparation involves physical examinations, changes in diet, activity, etc. that medical caregivers participate in, a large part of mental preparation lies in your hands. You should be emotionally prepared to motivate yourself through the changes and challenges that lie ahead. And to view the outcome realistically and objectively.
Expect a healthier version of you — in about a year after surgery. You will not wake up from surgery with a thinner body, but your body will be better equipped to start you on the right path to weightloss. Your stomach will be smaller, to restrict food intake. Weight loss will be gradual, provided you stick to the prescribed diet and activity plan. In the course of 1 year post-surgery, you will see a healthy loss of weight.
Approach food with a new mindset
After surgery, your diet will undergo a major change. You will be required to have liquids first and then slowly progress to solids. Smaller portions, slower consumption and well-thought out healthier leaner meals will bring the change you wish to see. A dietician can guide you at all times to align your choice of food to the stage of weight loss you are in now. Your weightloss might plateau at a point. Do not lose heart. A professional can review and make changes in your diet plan to continue your progress.
You can’t do away with activity. Regular activity as recommended will help accelerate you weightloss journey. Plan your activities to rule out boredom and to include what really works for you. Speak to your doctor to know your limits and requirements.
Psychological assessment — before and after — will help to clear your concerns and to open up about any fear your might have. If you have a difficult relationship with food, alcohol or drugs, a counsellor can support you in dealing with your demons.
Support and motivation
Support groups, family and friends play a great role in keeping you motivated. They can keep you focussed and keep your spirits buoyant. Include them in your weightloss journey. Open up to them about the wave of changes you will be going through physically and emotionally. This will take away the pressure on your relationships. Keep yourself motivated. Do not lose focus. With bariatric surgery, weightloss should be your number 1 focus. You work, lifestyle, diet and activities should be aligned constantly with this.
The effects of bariatric surgery can be life-changing. Make that change possible by preparing your mind to stay focussed and welcome a healthier body!
Diabetes is a disease affecting millions of people worldwide. Type 2 Diabetes is associated with obesity, overweight, lack of activity, heredity and aging. Medication, diet and exercise are usually recommended to manage the condition and to prevent damage to eyes, kidney, nerves and blood vessels. Diabetes can lead to heart failure, stroke, blindness, impotency, kidney failure, amputations due to uncontrolled infections, etc.
In Type 1 diabetes, the pancreas produces insufficient amounts of insulin. In Type 2 diabetes, the pancreas produce insulin, but for unknown reasons, the body is unable to use it. Type 2 diabetes is the most common form of diabetes. It is considered to be a chronic and progressive disease, since more often than not, the condition worsens requiring a higher dosage of medication.
Diabetes can be put in remission with the right medical interventions. Bariatric surgery has shown to reduce blood sugar levels to a normal range and in some cases even reducing the dosage or eliminating the need for diabetes medication. Concurrently, diabetes related health problems are also solved.
Effect of bariatric surgery on diabetes
A healthy and significant weight loss can help reduce blood sugar levels and can control Type 2 Diabetes. Bariatric surgery does help in reduction of weight. However, it has been shown in studies that obese patients do see a marked improvement in their diabetes status shortly after gastric sleeve surgery or gastric bypass surgery, even before significant weight loss.
Although this phenomenon is not fully understood, medical science is exploring the possibility of one or more of these factors at play:
Bypassing or removing a part of the stomach changes the way in which glucose is processed.
The new digestive tract influences the way hunger hormones work, making the patient crave less food.
When food is passed directly into the small intestine via the new digestive route, a substance is produced that probably increases insulin production.
These are theories that doctors are actively exploring to further understand the benefits bariatric surgery has shown in obese patients with diabetes.
Type 2 Diabetes is a serious condition that leads to debilitating complications. Prevention is the best way to avoid this. However, when prevention is no longer possible in overweight or obese persons, effective methods need to be adopted to bring their lives back on track. And for some, bariatric surgery may be the effective option.
With improving economies, health facilities and nutrition the world over, the foodies of the world have gone all out to splurge such that we are now being faced with an increasing global obesity epidemic.
Going out of shape and into being overweight, and then finally becoming obese is a tasty journey, but it comes with its own set of consequences and associated lifestyle diseases. And when your doctor tells you that there is no other way out, but to lose weight, getting back into shape really becomes the sword of Damocles. It requires a lot of discipline and dedication and hard-work before those kilos start shedding off.
You find out that exercise and diet are your only options. Both are tough and choosing between the two is like making a choice between the devil and the deep sea. On further research you find another exciting option – diet pills! Diet pills are however recommended only for special cases with a BMI above 27; for others, the cons outweigh the pros.
There are many approved and unapproved diet pills available, so make sure to check with your doctor before taking any. They may seem the ideal solution but they come with side-effects, some of which can be quiet serious. Generally speaking, prescription diet pills are only recommended for those groups of people who are unable to lose weight any other way and who have health issues associated with their excess weight. They may also lead to emotional dependence on the drug, and aren’t recommended for longer than 3-month periods.
These pills work in two different ways: by suppressing the appetite or by suppressing fat absorption. The former triggers the brain to suppress hunger, while the latter stops the body from absorbing fats, and unfortunately, the fat-soluble vitamins too!
Another con is that these pills tend to interfere with your metabolic processes and disrupt them to varying degrees. You may suffer from flatulence, cramps, diarrhea, constipation and incontinence, to name a few. They also affect the cardiac system by increasing blood pressure, heart rate and in some cases may even result in heart failure, thus consulting a doctor before taking them is crucial.
When theses pills are combined with a low-calorie diet and exercise, one can easily lose 5-10% of their body weight. Though this may not seem like much, it can actually decrease blood pressure, lipid levels as well as blood glucose levels.
It’s important to note however that these medications may not work for everyone and you might end up regaining most of the weight you lost.
Diet pills can be used to jump-start weight loss and provide the mental support to encourage the person to lose more weight through a proper diet and exercise plan – but that’s about all. The best road to health is always through eating a balanced and nutritious diet along with daily exercise.