Bariatric Surgery for Weight Loss
04 February 2022
Obesity is a problem faced by most in our society. In fact, Malaysia has the highest rate of obesity in Southeast Asia. According to the 2019 National Health and Morbidity Survey, 50.1% of adults in Malaysia are overweight. And there are people who take alternatives to overcome this issue by undergoing bariatric surgery.
Consultant General, Upper Gastrointestinal and Obesity Surgeon, Dr Azrina Abu Bakar said bariatric surgery is originally performed to lose weight by reducing the amount of food going into the stomach. But doctors later found that besides losing weight, the surgery can control diseases that are closely related to obesity such as diabetes, high blood pressure and high cholesterol.
"The term, metabolic surgery was then used because bariatrics is able to modify the metabolic elements of the patient's body, helping to control the diseases mentioned. The main purpose of bariatric surgery is for health benefits and not merely aesthetics like what people think when an individual's body shape changes after weight loss," she explained.
Bariatric surgery has restrictive elements that limit food consumption which indirectly reduces calorie intake, allowing weight loss in a controlled manner. However, to ensure a successful weight loss process, it must be accompanied by proper diet and physical exercise to burn existing calories.
There are several methods of bariatric surgery including gastrectomy and gastric bypass.
Dr Azrina explains for patients undergoing gastrectomy, food intake is very limited and the nutritionist will provide special regimens to ensure adequate calorie and protein intake, especially in the early stages after surgery.
"There are some patients who are not willing to follow the diet regimen provided, causing them to lack nutrients and resulting in them to feel weak. Long-term complications related to gastrectomy include reflux problems and narrowing of the alimentary canal. This causes patients to vomit repeatedly which may require them to undergo a gastric bypass to overcome the problem," Dr Azrina said.
She added that narrowing of the alimentary canal can occur after a gastric bypass due to surgical scarring. This causes the patient to vomit, have ulcer bleeding and intestinal obstruction due to convulsions, which may result in the patient having to undergo another surgery.
Patients should understand the purpose of bariatric surgery. Once the decision is made, the patient needs to undergo some evaluation including blood tests to detect diabetes and high cholesterol. Then a gastroendoscopic method is used to determine conditions in the stomach such as reflux problems, hiatus hernia, ulcers and tumours. Ultrasound is also used to assess the liver and other organs such as the adrenals or ovaries in women.
"Obesity is a disease involving various disciplines. If a patient has uncontrolled diabetes or cardiovascular problems, they will be referred to an endocrinologist or cardiologist. If the patient is suspected of having obstructive sleep apnea, they will be referred to an ear, nose and throat (ENT) or respiratory specialist to assess the need for the use of devices such as the Continuous Positive Airway Pressure (CPAP)," Dr Azrina said.
Once assessment is complete, patients are encouraged to undergo a very low calorie diet that limits calorie intake to 800kcal a day for 2 weeks to a month. This is suitable for patients who are overweight and helps them prepare for the post-surgical nutrition arranged by the nutritionist.
Dr Azrina stressed that there is no quick and safe methods to lose weight.
"The bottom line is that one must be aware of their health and have perseverance to maintain their ideal weight. Each procedure has its own potential risks and complications. Now there are methods to lose weight without surgery such as inserting a balloon into the abdomen (intragastric balloon)," she said.
Such a a procedure does not require the patient to face the risks of surgery but there are low risks and side effects that patients need to understand if they choose this method.