Bariatric Surgery - Dr. Baiju Senadhipan Bariatric Surgery - Dr. Baiju Senadhipan

Bariatric Surgery

”Leading the Fight against Obesity. Curing Diabetes and Host of other Lifestyle Diseases.”

cover-pic

Obesity is a leading cause of preventable death in the World and in India. More Indians are growing obese day by
day, accelerated by poor food habits and sedentary lifestyle. Many practices that people follow to cut fat and lose weight prove to be futile with in a short period of time. Several weightloss products sold in market with tall claims are fraudulent and often harmful. Hence it is extremely important to evaluate the options based on scientific evidence. Not based on anecdotes, societal reinforcement and heavy marketing.

Long term success rate of conventional weight-loss methods based on diet,  excercise, and behaviour modification is very low because these methods call for tremendous self-discipline and will power to be sustained with no relaxation over a patient’s entire life-time which spans over decades for young patients. This is a tough act to follow. Drugs play a minor role plagued with side effects and will perhaps continue to do so for a long period of time.

This situation has led to an explosion in bariatric surgery, today acknowledged to be the only method resulting in significant weight-loss maintenance and overall risk reduction- as quoted verbatim in a 2013 study called “Obesity Management: What brings success?” published in the American Journal of Therapeutic Advances in Gastroenterolgy.

However, few people know enough about it. Many do not fully understand it.

On the other hand there is excess information on the Internet but the source, accuracy and reliability of such information are often questionable.

To address these issues, Dr. Baiju Senadhipan, one of the leading experts of Bariatric surgery with an experience of more than 500 successful Keyhole Bariatric Surgeries takes time out to answer some basic questions about Obesity, Comorbidities, Bariatric Surgery etc.

The discussion below is in the form of Frequently Asked Questions (FAQs) by patients when they meet Dr Senadhipan with regards to their Obesity problems. Answers to those questions are in as simple words as possible to help you in making an informed choice. Hope you find this effort useful:

1. What is Obesity?

 Obesity is a condition of excessive fat accumulation in the body. An obese person is at higher risk of health complications like heart disease, diabetes, etc. There is a difference between being overweight and being obese. Your BMI or Body Mass Index determines if you are obese or not

 2. What is BMI?

 In order to determine whether one is Obese or not, it is necessary to calculate one’s Body Mass Index (BMI).BMI is measured by dividing a person’s weight in kgs by the square of a person’s height in meters.

key-holes

 

 

So for instance if one’s height is 175 cm and weight is 70 kg, the BMI would be calculated as follows :-

 BMI = 70 / (1.75 * 1.75) = 22.86

One can determine if one’s weight is normal, less than normal or higher than normal by checking the BMI calculated against the following chart.

BMI categories: 
Underweight            :               < 18.5
Normal weight         :               18.5–24.9
Overweight              :               25–29.9
Obese                      :               30 or higher

When one’s Body Mass Index is 30 or more, one is said to be obese.

However, you don’t have to do all the calculation. Just go to our website, look for BMI calculator, key in your height and weight and click enter.

You will get your BMI ready on screen.

3. I eat less than my friends do. Why am I obese while they are not?

Obesity may not always be due to overeating and lack of excercise although they are the primary reasons.

Two more underlying causes in many patients are malabsorption and malnutrition that render diet and excercise futile.

 Malabsorption is the inability to properly assimilate the nutrients in food regardless of diet, number of supplements taken, and eating habits.

Malabsorption is not food allergy. Food allergies, such as lactose intolerance, result from your body’s reaction to what it absorbs. Whereas in malabsorption, the problem lies in the very assimilation of those nutrients into the bloodstream.

Due to malabsorption, fats get deposited in tissues rather than getting properly used up by the body.

Also, people suffering from malabsorption have the tendency to crave more empty calories, as your body constantly sends false signals to the brain that it is deprived, regardless of how much you eat.

Malnutrition is another obesity trigger. The word malnutrition literally means bad nutrition. Traditionally the word malnutrition was associated with under nutrition of poor who have little to eat.

But hundreds of millions of people are malnourished today in the opposite sense because they are overweight, as well as having too much sugar, salt or cholesterol in their blood. Such people develop deficiency of microneutrients such as Vitamine D which create glucose intolerance paving way to type 2 Diabetes.

This is how Malnutrition, Obesity and Diabetes are closely linked with each other forming a deadly triad.

The other reasons for Obesity include side effects of certain medications, endocrine issues, and genetic issues.

However, it is interesting to note that only about 1% of obese have a genetic/hormonal reason for obesity (as reported in the American journal of nutrition)

4. I am overweight but I have no other health issues. Should I bother?

Yes. Being overweight may not currently have a bearing on your health. But it is likely to result in problems in the future.

In the long run, people who are obese / overweight are at a higher risk for developing the following conditions :-

  • Insulin resistance and type 2 diabetes;
  • high blood pressure;
  • heart disease and strokes
  • breast and colorectal cancer
  • sleep apnea
  • osteoarthritis
  • fatty liver disease
  • chronic kidney disease
  • problems during pregnancy (gestational diabetes, pre eclampsia, and increased risk for cesarean section

5. My friend recommended slimming tea to lose weight. The other day I saw an advertisement for body oils that can help in weight loss. There are pills, body bands and belts too that claim to induce weight loss. Are these products reliable?

Amongst a certain section of society today, slimming and weight loss has become a prime motivator and driving force. There is thus a huge market for products in this segment. These products take advantage of the desire amongst this group to lose maximum weight with the least effort in the quickest timespan. It is important to know that many of these claims are baseless and several of these products are fraudulent.

Click on the following links to take a look at some of the most fraudulent weight-loss products, promotions, claims and gimmicks that have emerged and vanished in the heath market one after the other since 1989 through 2013 :

http://www.healthyweightnetwork.com/fraud1.html

http://www.nejm.org/doi/full/10.1056/NEJMe1506236?af=R&rss=currentIssue

Before using such a product or service, it is important that you speak to your Doctor and verify the claims.

6. I recently came across a commercial weight loss program that proposes a 1 to 2 week schedule for complete weight loss. Are these sort of programs reliable?

 In general, Slimming programs offer a guide to eating healthy food, group encouragement and moral support, exercise and movement advice and a set routine or plans to follow each week are also provided. However, this comes at a very high cost.

Most often, many of the participants follow the guidelines initially and thereafter, return to their old routine. The impact and benefit of these programs is hence only felt in the short run. There is no long-term impact.

The British Journal of Nutrition in April 2008 records that about 20% of participants in such programs maintain their goal weight for 2 years and in 5 years that figure goes down to about 16%.  It mentions that “these programmes are successful because the other 84% have to come back and do it again. That’s where their business comes from”

Before taking a decision about the route one wishes to take to tackle the problem of excess weight or obesity, it is necessary that one obtain the relevant information and make an informed choice

7. My friend suggested liposuction as a method of weight loss. What is Liposuction? Is it same as bariatric surgery?

No. Liposuction is not the same as Bariatric surgery.

Liposuction is a cosmetic procedure that sucks fat through a slender pipe called cannula from the body in order to alter the shape of the person’s body.

Liposuction performed by a competent plastic surgeon is useful in loosing small amounts of stubborn fat in abdomen, around waists etc. to improve cosmetic appearence.  Normally two to five litres of fat is removed in one sitting. More fat removal need multiple sessions.

Besides, there are painful bruises on body post the procedure that take time to heal.

Liposuction does not claim to solve obesity related comorbidities such as Diabetes and host of other conditions.

In contrast, Bariatric surgery is a metabolic surgery which can help lose massive amounts of excess weight in morbidly obese. For example 50 to 100 Kilo excess weight loss in a safe and long term manner is common after Bariatric surgery.

Keyhole Bariatric Surgery is virtually painless post operatively due to three to four miniature incisions on abdomen each having a size of 5mm -12mm (one to three rice grain size). Smaller incisions also mean quicker recovery where a patient is discharged normally within two to three days after surgery. Miniature incisions also present much less chances of surgical site infections comapared to a conventional open GI surgery.

Bariatric surgery cures comorbidities such as Type 2 Diabetes, Blood Pressure and host of other conditions almost immediately in most number of patients, even before the patient is discharged from Hospital.

1-liposuction-is-sucking-out-fat-from-under-the-skin-with-a-vacuum-tool-12-bariatric-surgery-deals-with-altering-gastrointestinal-metabolism

8. Is there a scientifically proven weight loss treatment method other than following a healthy diet and regular exercise?

Yes. The only method scientifically proven to lose weight in obese patients other than regular exercise and healthy diet is Bariatric Surgery. The risk of Deep Vein Thrombosis and its sequelae are especially more in Bariatric patients. We take precautions to prevent them

9. What are the risks of Bariatric surgery?

 The risks of bariatric surgery are the same as those related with surgery in general. Namely risks related to anesthesia, leak, bleeding, etc.

Hence it is important to choose a well established and experienced Center in Bariatric and Keyhole Surgery to minimize the chances of these risks.

10. What exactly is Bariatric Surgery? How does surgery cure my problem of obesity?

Bariatric Surgery is also called Metabolic Surgery. It is a procedure to induce weight loss amongst people who suffer from Obesity. It is primarily intended for those with a very high BMI of over 35, have atleast one comorbidity and for whom other weight loss measures have not worked.

The basic idea of a bariatric surgery is to reduce the size of the stomach of the patient either by restricting the size by using a band or by resecting a part of the stomach. This results in reduction of the food intake per meal, higher levels of satiety during the day and long term weight loss.

 11. What are the different types of Bariatric surgery?

 There are four types of operations that are commonly offered:

  1. Adjustable gastric band (AGB),
  2. Roux-en-Y gastric bypass (RYGB)
  3. Biliopancreatic diversion with a duodenal switch (BPD-DS)
  4. Vertical sleeve gastrectomy (VSG).

Each has its own benefits and risks. To select the option that is best for you, you and your physician will consider that operation’s benefits and risks along with many other factors, including BMI, eating behaviors, obesity-related health conditions, and previous operations

12. How will my diet be affected after the procedure?

After a bariatric procedure one is required to have small frequent meals. As the stomach size is reduced, one tends to feel full with smaller quantities. The food intake will thereby reduce on its own.

13. When will the results of the bariatric surgery be visible?

The impact of bariatric surgery becomes apparent within the first few weeks of the surgery.

14. What are the side effects of Bariatric Surgery?

 Weight loss surgery as with any major surgery has risks of which you should be made aware of. These may include:

  1. An internal infection from leakage of digestive juices into the body cavity
  2. Development of gall bladder disease and / or gall stones – due to rapid weight loss
  3. Blood clots – may cause a more serious condition called a pulmonary embolism
  4. Vitamin deficiencies – may be preventable by taking daily vitamin supplements. Periodic lab testing may also be required

 15. Can there be any future health issues due to Bariatric Surgery?

 It depends on the type of the procedure the surgeon chooses.

The patient is advised to have minerals and vitamin supplements when found necessary

16. Can bariatric surgery be performed during pregnancy?

The gastric bypass surgery must be avoided during pregnancy. A pregnant women is advised not to undergo bariatric surgery during the pregnancy.

 17. I have heard that Cholesterol, BP and sugar levels improve after the surgery. Is this correct?

Yes. After bariatric surgery, sugar levels, cholesterol and blood pressure improve significantly and in most patients the readings get totally normal after surgery.

18. What kind of Anesthesia will be given to me for a bariatric surgery?

Bariatric surgery is performed under General Anesthesia.

19. Will there be post-operative scars after the surgery?

As the procedure is performed laparoscopically, there will not be major scars as one has in open surgery. There will only be miniature scars that are barely visible to naked eye. i.e. the size of one to three grains of rice.

20. A number of hospitals are offering bariatric surgery for weight loss. How does one choose between these centres?

Most significant factor in the decision is the skill and expertise of the center. The success of a surgery and the patient’s experience depends mostly on the experience, skill and expertise of the Bariatric team that includes Keyhole Surgeon, Bariatric Anaesthetist, Endocrinologist, Dietician, Counseller and Trained OT staff. Number of Bariatric surgeries performed by the center and testimonials of patients having undergone the surgery at the center can also provide a good proxy.

 21. What is the average cost of a bariatric surgery?

 The cost of a bariatric surgery is approximately 2.5 to 3.5 lakhs at our Center.

 22. Why does bariatric surgery cost more than other surgeries?

 This could be a misconception because it costs almost same as other surgeries in its class.

Secondly, compared to the life time cost of managing comorbidities such as Diabetes, High blood pressure etc and their complications through procedures such as angioplasties etc. might prove much more expensive, lifestyle restrictive, and life threatening in the long run.

 23. Are there good centres for bariatric surgery in the public sector?

There are very limited options for bariatric surgery available in government hospitals.

 24. Is Insurance cover available for Bariatric Surgery?

 Yes. Insurance cover is available for some bariatric surgery. You can contact your Insurance Agency for more information.

 25. Has your centre performed Bariatric Surgeries?

 Yes. Our team has successfully performed over 500 Bariatric Procedures laparoscopically which is one of the largest numbers in Kerala and India. All our patients have gone on to enjoy much higher quality of life after their bariatric surgeries at our centre.