It isn’t a shortcut to weight loss

People who believe that it is a short cut for weight loss are generally not the ones who need it. This is for people who have honestly tried to lose weight and tried various gyms, diets, have gone and have lost weight which keeps coming back.

Typically, bariatric surgery is advised for those patients who are at least 25 to 30 kilos overweight with BMI 32.5 or above. People with severe diabetes, hypertension or obstructive sleep apnoea associated with obesity are also likely candidates. Women who have irregular periods and are unable to conceive due to obesity can also opt for the surgery.

Bariatric surgery can be performed on all kinds of patients except if they have an unstable heart condition or untreated angina, or are psychologically unstable in which case they don’t understand/appreciate what is required after bariatric surgery and will not follow-up.

Role in treatment of Diabetes

Bariatric surgery plays an important role in treatment of Type 2 diabetes by changing the hormonal levels in the blood. The insulin that is produced in the body becomes sufficient.

Insulin resistance is increased and blood sugar is controlled. Over 80 % of the patients after the surgery will have normal blood sugar without medicines which is very significant because worldwide 60% of patients have uncontrolled blood sugar levels even with medicines.

Choosing a good surgeon is important

No surgery is a minor surgery. Hence before choosing a surgeon it is important to know if the surgeon can offer the entire range of surgeries. If a surgeon knows only one procedure, he will offer only that procedure which may or may not be suitable for you. Look for a surgeon who is a dedicated bariatric surgeon and has performed over 100 bariatric surgeries a year. The more experience a surgeon has in bariatric surgery, the less chances of complication rates. A dedicated bariatric surgeon will have time to spend with the patients after the surgery and will see you two to three times in the first year after surgery and once every year thereafter. Also make sure that the surgeon has a team of support staff with him – a dietician, a physician, a psychologist and counsellors. In case of any doubt talk to your other patients the surgeon has operated on and ask them about their personal experience.

Liposuction and Tummy Tucks are cosmetic procedures

They are done in a person whose weight is normal or near normal but has excess fat in particular parts of the body. Liposuction removes excess fat from thighs, back etc. Tummy tuck is done in the lower part of abdomen. The part of the abdomen that is in excess is tucked or removed and the skin is tightened so that you get a flat tummy. Other bariatric procedures are Sleeve Gastrectomy, Gastric Banding and Gastric Bypass.

Care before and after surgery

Many instructions are given before surgery to ensure that the procedure is safe for the patient. Tests to evaluate fitness before surgery which include heart, lung and kidney check-up, liver function, cholesterol, etc. are conducted. If any correctable problem or deficiency is diagnosed in these tests, then it should be attended to. Most of the people who are overweight by 25 to 30 kg also have a fatty liver. Such patients are put on a diet for one to two weeks before surgery primarily to reduce the fat content of the liver and not for weight loss. Patients are also taught breathing exercises.

After the surgery, patients are discharged either the same day or after 24 hrs. They should be on a liquid diet for about two weeks to ensure healing after which they are advised to be on a soft diet for a while. They are also prescribed supplements of protein, vitamin, calcium and iron to compensate for the deficiency of nutrients during the healing period.

Cost factor

The cost of surgery depends on where it is done and which procedure is being done. On an average the cost of bariatric surgery would be between two to three and a half lakh Indian rupees. At the moment it is not covered by insurance in India. Hence, majority of the patients pay from their pockets.

Lifestyle changes and weight loss after surgery

Bariatric surgery is just a tool. Making the right lifestyle changes is the most important decision that the patient needs to make. If patients eat good quality food and are physically active, they can lose anywhere between 70 to 95% of their extra weight. For e.g. if a person weighs 120 kg as against the ideal weight of 60 kg, he/she can expect to lose around 45 to 55 kg. The younger the patient, the better the weight loss is because young patients are more physically active.

Making the right food choices is paramount post-surgery. Since the quantity of food taken will be small, they need to eat protein-rich foods like pulses, milk products, eggs, fish, chicken, etc. Also, patients need to exercise, especially train with weights on a regular basis.

In some patients who have lost adequate weight after bariatric surgery the excess skin surrounding their pre-op fat becomes loose. This can be avoided by having enough proteins, water, vitamins, by exercising regularly and by getting body massages. After bariatric surgery less than 1% of the patients need plastic surgeries like tummy tuck or thigh lift.

Risks involved

The risk with bariatric surgery is primarily the same as with any other surgery. The risk is associated with anaesthesia, how the surgery is done and how the follow-up is done over a period of time. After the surgery, the risk is only of nutritional deficiency which can be completely avoided with patient compliance and regular follow-ups.

It is a misconception that the surgery restricts the absorption of nutrients causing malnutrition. Most of the bariatric surgeries work on the principle of reducing the portion size and not on malabsorption. There are very few procedures which work on principle of malabsorption and are not done in countries where there are more vegetarians. It is possible that some patients may have malnutrition which can be completely prevented by following post-operative guidelines and having more proteins, vitamins, calcium and iron in their diet.

George said, in conversation with IANS, that initially patients arrived in the hope of managing their weight. Once the results of the procedure were seen by others, even more people wanted to go under the knife to cut flab.  ‘In the two years since we first began, we have done this on a thousand patients,’ George said. Latha Nair, a medical professional herself, and her husband, worried about their son’s weight until they came into contact with George.  ‘At 180 kg, my son was hypertensive and introverted. We had tried all sorts of diets and exercise regimen, but nothing seemed to work with him. We then met George. After our son underwent laproscopic sleeve gastrectomy (LSG), his weight has reduced to 87 kg. As parents, we are just as relieved as our son is,’ said Latha Nair.

A. Harris, George’s closest aide, who partners him in surgeries, said obesity is now a menacing pandemic, a modern lifestyle disease.  ‘India and South Asia now have almost as bad an obesity problem as the US, where 60 percent of all adults are obese. Since 2011, WHO has recognised obesity as a disease,’ Harris said. These days, anyone with a body mass index of over 30 is considered obese.

‘Although genetic factors play a role, lack of exercise and the growing fast food culture are the main causes of obesity. Weight loss is almost never achieved with just exercising and dieting, and bariatric surgery has now been accepted as a permanent solution,’ said George, who pointed out that diabetic patients who underwent this procedure could sometimes drop medicines for diabetes.

G. Jijimol, who used the procedure to shed 35 kg and now weighs 65 kg, said: ‘I was finding it difficult to cope. My shape made me stick out like a sore thumb. I was sceptical when I first heard of this procedure, but I am so happy with how things have shaped up. I no longer feel so tired playing with my kid.’  It helps that surgery is performed in Kerala cheaper than elsewhere in the world.  ‘In a week, the patient is back to normal. On an average, the entire procedure would cost around Rs 2.50 lakh,’ George said. 

Source: IANS

The researchers are now planning to begin treating obese dogs later this year. If successful and found to be safe, it is hoped that the treatment could be available for use in humans in around six years, according to the Telegraph. Ouliana Ziouzenkova, human nutrition researcher at Ohio State University, said: “We found the capsules completely remodelled the fat they were put into.” ”Our goal was to achieve a way of targeting deleterious visceral fat that increases the risk for diseases like type 2 diabetes and cardiovascular disease.”

“We have to prove that this is safe and effective in humans, but we could think about using it for body sculpturing. So if you wanted to remove a small amount of fat under your face like a double chin, or in their arms or legs, you could target these with a single injection.  ”We have a grant now to carry out some work with obese dogs as it could also be of great benefit for veterinary purposes as there is a growing problem with obese pets,” added Ziouzenkova.

Researchers believe the capsules, three times as thick as human hair, could be injected into specific fat deposits such as the thighs, buttocks, arms or under the chin to reduce the amount of fat stored there. Ziouzenkova and her colleagues used fatlike cells from mice that had been genetically modified to burn off excess energy as body temperature.  They found that by encasing these cells inside plastic-like microcapsules, they could be transplanted without being destroyed by the recipients immune system.

Source: IANS

In humans, abdominal obesity or the beer belly is often synonymous with Type 2 diabetes, cancer, heart disease and hypertension.  Scientists took advantage of the heat-generating properties of a so-called ‘good fat’ in body, to cut back on the white cells that compose the visceral fat. They combined those brown fat thermogenic cells with genetically modified cells missing an enzyme that leads to visceral fat growth. The engineered cells were placed inside a gel-like capsule that allowed for release of its contents without triggering an immune response.

“With a very small number of cells, the effect of the injection of this capsule was more pronounced at the beginning, when the mice dramatically lost about 10% of their weight,” said Ouliana Ziouzenkova, assistant professor of human nutrition at Ohio State University and lead author of the study. “They gained back some weight after that. But then we started to look at how much visceral fat was present, and we saw about a 20% reduction in those lipids,” he said.

 The research has been published in the journal ‘Biomaterials’.

Before you jump on that tummy-tuck bandwagon too, you should know what the procedure is about. We bring you a brief introduction about the procedure.

The tummy tuck procedure, also called Abdominoplasty is a procedure that removes excess fat and skin creating firmer and shapely abs. Ideally, it is not something which can replace weight loss with exercise and a good diet. It is indicated for people who are unable to get their abs in shape even after a lot of exercise (core conditioning). Usually, people opt for it after pregnancy or if they have a tummy due to heredity. At times, even when people lose a significant amount of weight, the skin over the abdomen hangs loosely and hence might need a tummy tuck.

But do bear in mind that it is a good option only if you are physically healthy and at a stable weight and are committed to fitness for life. It is advisable that you delay the procedure if you’re planning a pregnancy or lose a significant amount of weight  in the near future.

People often confuse liposuction with a tummy tuck. While liposuction only removes the fat in certain areas, a tummy tuck removes fat and the overlying skin too. Sometimes, a liposuction may be done as part of the tummy tuck.

Being a surgery after all, it does have its complications. There might be pain and soreness for several days. Infection and bleeding under the skin flaps can also occur. The risks are increased if you have diabetes, heart, lung or liver disease. A few people who’ve undergone tummy tucks do report ugly scarring.

So, before you get under the surgeon’s knife, do your research and get your facts in place. Consult an experienced surgeon, understand the procedure, it’s pros and cons and then go for it.