BARIATRIC SURGERY IS THE BEST OPTION TO FIGHT OBESITY

 

One condition which has become an issue for global health concern is obesity. This is due to its rapidly increasing prevalence and association with other metabolic abnormalities such as type 2 diabetes, heart and coronary disease, high blood pressure and high lipid levels to mention but a few. The constellation of two of these metabolic anomalies is called metabolic syndrome. 

Obesity results when the body takes in more calories than it utilizes or burns. The excess is stored up as fat or adipose tissue in different parts of the body with resultant increase in body size and weight gain. Truncal obesity (fat deposition around the tummy and waist) is much more dangerous as it can lead to insulin resistance and rapid development of Type 2 Diabetes Mellitus. Factors which predispose to the development of obesity include a sedentary lifestyle, poor dietary habits, lack of exercise, socio-economic factors, race and genetics. 

Obesity management over the years has rested on lifestyle changes, dietary modifications, increased exercise and use of drugs. These have largely proven ineffective in managing obesity. Dieting may lead to weight loss in the short term but this is very difficult to maintain. In the long run, individuals - even the most disciplined of the lot- end up regaining back previously lost weight. Success rates range from 2-10%.

Surgical options have proven successful in the management of obesity. Weight loss surgery or Bariatric surgery refers refers to surgical procedures which make use of Bariatric techniques (ileal interposition, adjustable gastric banding, gastric sleeve surgery, gastric bypass surgery, duodenal switch etc). Bariatric surgery options as at today remain the most effective and best treatment for achieving weight loss in obese individuals. In addition to its ability to cause sustained weight loss, it also improves or leads to a remission of many co-morbidities associated with obesity especially Type 2 Diabetes Mellitus (there is post-op regulation of blood sugar which comes about due to increase in insulin sensitivity, increased secretion of insulin and restriction in caloric intake as a direct result of the surgical procedure). Therefore techniques based on treatment of type 2 diabetes in non-morbidly obese individuals are named as Metabolic Surgery.

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Bariatric surgery options are broadly divided into 3

1.      Gastric restrictive procedures which reduce the volume of the stomach and consequently caloric intake by decreasing hunger. Patients have gone on to lose 10-20% of their weight. 

·         Sleeve gastrectomy

·         Adjustable gastric banding

·         Vertical gastroplasty 

2.      Intestinal bypass procedures: these shorten the length of the small bowel leading to decreased nutrient and fat absorption, while also limiting caloric intake. 

·         Gastric bypass surgery (Roux-en-Y Gastric Bypass OR Minigastric bypass surgery)

·         BPD-DS (Bilio-pancreatic Diversion - Duodenal switch)

These procedures are associated with exclusion of the duodenum and proximal part of the small bowel and thus are resulting in vitamin and mineral supplementation due to the intestinal bypass.

3.      Intestinal re-routing procedures:

·         Ileal interposition

·         Transit Bipartition 

These procedures are technically based on inter positioning or trans positioning of the last part of the small bowel without an exclusion or bypass. They result in appropriate control of type 2 diabetes with no long term vitamin and mineral requirement.

All these procedures result in better long term weight loss than traditional dietary and lifestyle methods. In addition, patients with Type 2 Diabetes Mellitus also have their blood sugar controlled in about 90% of cases post-op. This is due to the role of the gut hormones in the regulation of blood sugar. 

Most of the Bariatric surgery procedures for weight loss are performed laparoscopic ally resulting in faster recovery times and decreased risk for post-op complications, lower morbidity and mortality in comparison with open surgery. 

Thus in contemporary times, bariatric surgery is the best option in the medical arsenal for the treatment of obesity due to its effectiveness in achieving weight loss and other concomitant benefits.