Bariatric Surgery: Reducing Mortality and Improving Health Outcomes

Obesity is both associated with and predisposes to a barrage of medical conditions which have a significant impact on the lives of individuals. These include diabetes mellitus, cardiovascular conditions such as stroke, hypertension, to mention a few. Management remedied for attaining weight loss have usually centred on lifestyle modifications -  exercise, adopting healthier diets and eating healthy - and drugs.

Despite the discipline required to follow through on lifestyle changes, only a few individuals lose significant weight, and this weight is more often regained in no distant time. This can prove both frustrating and discouraging.

Surgical options have been tried out with excellent results. Bariatric surgery makes use of bariatric techniques such as bariatric surgery sleeve, ileal interposition and transit bipartition. These procedures are associated with excellent weight loss, better long term maintenance of weight, improvement in complications, and an overall reduction in mortality. Thus, bariatric surgery is now the most effective means of achieving weight loss.

Studies published in American journals have come up with the finding that obese individuals who underwent bariatric surgery had a reduction in mortality and improvement in health outcomes compared to other obese individuals who relied on lifestyle modifications and medical management.

Researchers at a tel Aviv hospital who compared 8385 obese patients who were matched with 25155 other patients who had no surgery, discovered that those who did not have surgery done, had almost double the mortality of those who had bariatric within the follow up period.

A related study at the University of Minnesota found that patients who had bariatric surgery had better health outcomes within a 5year period. Thus, in addition to causing weight loss, which is a short term effect, there is a long term improvement in health outcomes (such as better sugar control, blood pressure control, decrease in circulating blood cholesterol levels), and a decrease in mortality compared to obese patients who didn't have any surgery done.

These beneficial effects are achieved by several mechanisms which include

-an alteration in the capacity and absorptive characteristic of the gut

- causing hormonal changes in the body.

These benefits lead to improvement in co-existing morbidity, improvement in the quality of life, and consequently increased longevity and decreased mortality from various causes. Hence, bariatric surgery sleeve has the potential to offer a new lease of life to obese patients when they undergo the procedure. 

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How Metabolic Surgery Can Stem Medical Conditions

Being overweight and obese predisposes individuals to a plethora of other medical conditions which include hypertension, non-insulin dependent diabetes Mellitus (type 2 diabetes Mellitus), cardiovascular diseases, dyslipidemia and many others. In addition, certain individuals face depression, a poor self-image and even body-shaming by other individuals.

All these aforementioned reasons have pushed people to seek out rapid weight loss remedies. Options which individuals usually try include, dieting, restriction of food intake, increasing physical exercise and even the use of drugs and other unconventional methods. These have proven in the long run to have minimal or marginal effect in rapid weight loss and maintenance of lost weight over prolonged periods. Individuals also have difficulty sticking to dieting regimens or the discipline to follow through on a workout routine or gym plan.

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Herein lay the benefits or advantages of metabolic or weight loss surgery. This option has been proven to be the most effective method of achieving weight loss rapidly and maintaining lost weight. Metabolic surgery, weight loss surgery or diabetic surgery - all are essentially one and the same - utilize bariatric techniques like transit bipartition and ileal interposition. They lead to effective and rapid weight loss.

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A proven benefit of metabolic surgery, in addition to achieving weight loss, is that it leads to resolution or improves other medical conditions in the long run. Such medical conditions include Type 2 Diabetes Mellitus, hypertension, arthritis, obstructive sleep apnea, fatty liver disease, dyslipidemia etc. Obese individuals who were diabetic and had undergone surgery for obesity were noted to have gone into remission some years later without the need for insulin therapy.

Although the exact mechanism by which surgery leads to the achievement of these benefits is still unclear, several explanations have been put forward. These include the ability of this surgery to modify the level of certain gut hormones which leads to improvement and stems some of the medical conditions outlined above. Some of these gut hormones increase satiety, increase secretion of insulin by the pancreas and increase the sensitivity of body cells to insulin. These can lead to improvement in type 2 diabetes Mellitus and lead to possible remission.

Rapid weight loss leads to a decrease in pressure on the body's weight-bearing joints, decreasing arthritis. It also improves sleep and reduces apnea episodes in individuals with obstructive sleep apnea. In addition to stemming medical conditions outlined above, metabolic surgery also helps improve longevity and overall quality of life.

Contact your physician today to discuss your fitness for metabolic surgery and the various options available for you. 

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What are the Procedures for Metabolic Surgery

Diabetes, commonly known as a sugar disease by society, has been increasing world-wide over the last few decades. What treatment have you been applying to cure diabetes? Which diabetes patients benefit from this treatment and who are appropriate candidates for it?

We have been treating type 2 diabetes patients using a surgical method. It is called Metabolic Surgery. The classic treatment paradigm of type 2 diabetes is education, diet, exercise and the use of medication. But the disease may take a progressive course despite all these treatments. Sometimes, even in spite of intensive insulin use, effective results are unobtainable. In such cases Metabolic Surgery should be considered as an effective treatment alternative.

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Health Guide: Pros and Cons of Weight Loss Surgery

As a common knowledge, obesity and weight gain are gradually attaining epidemic proportions globally. This is due to our increasing appetite for unhealthy junk foods, sedentary lifestyles, a lack of exercise and for some, a background genetic predisposition. Further compounding the problem of obesity are the other health conditions which it predisposes individuals to. These health risks include an increased risk for type 2 diabetes Mellitus, cardiovascular diseases, hypertension etc.

Although conventional approaches have focused on achievement of weight loss through dieting, exercise and drugs, these have continued to prove unsatisfactory especially in terms of their ability to cause weight loss and maintenance of the new weight. To tackle this problem, a new approach was sought, which led to the birth of weight loss surgery. This has proven over time to be an effective means of achieving weight loss. Weight loss surgery employs Bariatric techniques and options which include sleeve gastrectomy, ileal interposition, transit bipartition etc.

As with all medical/surgical procedures, weight loss surgery by Metabolic Surgery Clinic also comes with its own set of pros and cons which we shall briefly explore. It is best to approach each weight loss surgery option, detailing its pros and cons. 

Sleeve gastrectomy

Pros

·        There is rapid weight loss of as much as 30-50% within the first 6 months to 1 year.

·        There is improvement in obesity-related complications such as Type 2 Diabetes Mellitus and hypertension.

·        There is decrease in the gastric capacity leading to decreased hunger and eating of small meals.

Cons

·        There may be leakage at stapling points on the stomach which can predispose to other complications such as infections.

·        There may be some form of malabsorption.

Biliopancreatic diversion with duodenal switch

Pros

·        Achievement and maintenance of rapid weight loss in the long run

·        Decrease in gastric capacity, decreased hunger and eating of smaller meal portions

Cons

·        Predisposition to micronutrient deficiencies which can be corrected with adequate supplementation.

·        It is technically difficult to carry out due to the complexity.

·        There is increased chance of intra-operative and anesthetic complications.

From the information provided above, there is no single best option for every obese or overweight patient. It is generally advised for patients to discuss with their primary care physician or an expert on the option which best suits their unique situation. 

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IS WEIGHT LOSS SURGERY A PERFECT SOLUTION TO FIGHT OBESITY?

If there is one chronic condition which has come to define 21st century man, it is obesity. Estimates classify 1/3 of the American population as obese while 2/3 are classed as overweight. Similar statistics are reflected in many developed countries with developing countries jumping on the bandwagon due to increasing adoption of Western diets and lifestyles. 

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HOW WEIGHT LOSS SURGERY WORKS WHEN DIETS DON'T

An all too familiar feeling despair and sometimes disappointment crops up among individuals who have begun to gain weight after working so hard to lose it. This stems a feeling shared by numerous obese patients going through one exercise regimen or dieting protocol to lose weight. Over time, exercise, dietary modifications and even drugs have continued to prove ineffective in enabling obese or overweight individuals to lose weight and even when they are disciplined and committed enough to follow through on their desired regimen. Whatever weight is lost is quickly regained in the door term as the body has reprogrammed itself to lower it's metabolic rate, thus leading to accumulation and conservation of calories even in the face of dieting.

An exciting option which has proven very effective over r time in helping obese individuals lose weight and maintain their lost weight in the long run is metabolic surgery, weight loss surgery or diabetes surgery. Weight loss surgery helps obese individuals achieve excellent weight loss results. It involves the use of Bariatric techniques such as gastric bypass, adjustable gastric banding, ileal interposition, transit bipartition, sleeve gastrectomy etc.

A quick question which comes up is, why or more appropriately, how weight loss surgery works when diets don't?

Weight loss surgery typically achieve the following effects

·         Decrease in the capacity of the stomach, thus reducing the amount of food intake and increasing satiety with smaller meals. This is difficult to achieve with dieting alone.

·         Decrease the length of the gut leading to decrease in absorption of nutrients.

·         Modification of gut hormones, leading to decreased hunger and increased satiety with smaller meals.

·         Increase the metabolic rate of the body.

·         Increasing insulin secretion and increasing the sensitivity of body cells to insulin.

All these work together to ensure rapid weight loss and also maintain weight loss, preventing regaining of weight in the shortest possible time.

Diets on the other hand require a lot of discipline to stick to and relapses typically occurs among individuals. In addition, in obese people, the body cells are already primed, causing them to lower the body's metabolic rate enabling them to conserve energy and store up fat. This leads to regaining weight.

Added to the achievement of significant weight loss, weight loss surgery has also been noted to improve metabolic conditions such as Type 2 Diabetes Mellitus, with diabetics achieving remission and good blood sugar control in the long term.

Of the various weight loss surgery options available, the one which produces the most drastic result is gastric bypass surgery. However, in choosing the best option for you, a lot of factors need to be considered including cost, desire for reversibility, long term effects etc. These factors must be considered and discussed with your physician in order to arrive at the best weight loss surgery option for you.

After weight loss surgery, the body undergoes the transformation in order to adjust to the new status quo. A knowledge of these possible transformations is essential to preparing for adequate adjustment.

·         The most obvious change is significant weight loss. Get ready to alter your wardrobe too.

·         Due to the laparoscopic approaches used, recovery typically takes 1-6 weeks.

·         Some procedures require you to take some vitamin and mineral supplements after surgery.

·         You'd be expected to eat small meals,  more frequently than before. Getting adjusted to this meal plan can sometimes be difficult for some individuals.

·         Exercise is important as it helps you to keep off lost weight.

·         Some challenges with rapid weight loss include aesthetic issues such a short saggy skin.

·       Some patients have been noted to have some mood swings and even depression. It is good to have supportive family, friends or social support.

Working with your physician and keeping to your appointment schedule helps you cope with the transformation and help you live healthier and happier after surgery. 

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IS WEIGHT LOSS SURGERY A PERFECT SOLUTION TO FIGHT OBESITY?

If there is one chronic condition which has come to define the 21st-century man, it is obesity. Estimates classify 1/3 of the American population as obese while 2/3 are classed as overweight. Similar statistics are reflected in many developed countries with developing countries jumping on the bandwagon due to increasing adoption of Western diets and lifestyles. Further compounding this problem is the sedentary lifestyle, a lack of exercise and genetic predisposition in some individuals.

Traditional approaches to management of obesity have focused on lifestyle changes, dieting and drugs. There is currently a plethora of dieting regimens, exercise routines and drugs which are offered as options for weight loss. Sadly, however, results from these traditional approaches have been less than satisfactory. Individuals who lose weight tend to regain it in the long run. Even the most disciplined of individuals are not spared of this fate.

In a bid to address this gap created by traditional approaches, other options are being explored to achieve weight loss. One option which has proven effective and promising is Weight loss surgery. Weight loss surgery, bariatric surgery or metabolic surgery makes use of Bariatric techniques which include gastric bypass surgery, transit bipartition, ileal interposition, and sleeve gastrectomy among others.

These use minimally invasive techniques or laparoscopic approaches during surgery. Impressive and phenomenal results have been posted thus far with many patients attaining weight loss within a short period of time and maintaining stable weight loss over the long term. In addition to causing weight loss, it also has other associated benefits such as improving insulin sensitivity of body cells, increasing insulin secretion, increasing satiety and improving symptoms of metabolic syndrome. All these add up to make it the magic bullet in the management of obesity. The laparoscopic nature of the procedure makes it less fraught with complications during surgery and post-op, less hospital stay, rapid weight loss, and rapid recovery.

As with all surgical procedures, it has some side effects but these are overshadowed or dwarfed in comparison to the overwhelming benefits of weight loss surgery.

Despite the glaring benefits, is Weight loss surgery open for everyone?

Though a proven treatment option for attaining rapid weight loss, certain criteria make certain patients qualified for weight loss surgery. These indications include the following:

·         Individuals with BMI of 40 and above

·         Patients with BMI of 35 and above who have at least one other obesity-associated health condition which includes type 2 diabetes Mellitus, cardiovascular disease, hypertension, dyslipidemia etc.

·         Type 2 Diabetic patients with BMI of 30 and above who fail to achieve adequate blood sugar control despite best medical treatment.

·         Patients who have been unable to achieve optimal weight loss despite efforts.

·         Obesity that is refractory to all other interventions.

Individuals who meet any of the above criteria are potential candidates for bariatric surgery. Thus in the light of all the obvious benefits and extreme effectiveness in achieving weight loss in obese individuals, it should not be used as a first line approach, rather, it should be explored only after efforts have been made to adopt a healthy lifestyle and dieting habits. It is when these fail despite disciplined attempts or the patient falls into any of the category described above, do they qualify for weight loss surgery.

Thus although currently the most effective treatment for obesity, weight loss surgery should not be considered as the first option in the management of obesity and achievement and maintenance of weight control. 

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