THE word Bari or Baros in modern Greek means weight, burden, obese. Bariatric surgery is surgery for obesity. It is currently the only effective and sustainable weight loss method for those who have difficulty in losing significant weight despite food restriction and exercise.

An obese person tends to have multiple medical problems such as diabetes, hypertension, hypercholesterol and so on, hence bariatric surgery is not only for obesity, it also improves or helps alleviate such conditions. That is why it is sometimes referred to as metabolic surgery.

There are different types of bariatric surgeries which possess restrictive (reduce the amount of food intake) and hormonal effects (changes in body hormones to reduce absorption and digestion of food).

The standard types of procedures include:

• Sleeve gastrectomy – This procedure aims to reduce the size of the stomach. This will help to reduce the amount of food intake. The procedure involves removing most of the stomach, and this is irreversible.

• Roux-En-Y Gastric Bypass (RYGB) – This procedure involves creating a small stomach pouch (bag), leaving a small upper chamber and big lower chamber. The small intestine is then divided at a certain length (usually about 100cm from the duodenum). The first end is joined to the upper chamber.

The second is connected from the lower chamber (the disconnected stomach and duodenum) to the small intestine. This procedure will not remove any part of the stomach or intestine.

The amount of food intake will be reduced. Food entering the stomach will bypass the duodenum (first part of the small intestine) and jejunum (middle segment of the small intestine) into the later part of the small intestine. This will delay food digestion and absorption.

This is a restrictive and malabsorptive procedure.

• Adjustable gastric band – This procedure entails inserting an inflatable balloon into the upper part of the stomach. The balloon is attached to a port placed underneath the skin for adjustment. This band helps to create a small pouch of the stomach, limiting the amount of food intake and delaying food from entering into the remaining stomach. This will help to create a feeling of fullness.

We will have more options in the near future. These are currently under investigation/research.

What happens to the body after bariatric surgery?

The end goal of bariatric surgery is weight loss. While losing weight, the body goes through several other physiological changes due to restriction in diet.

For those with diabetes, sugar control will improve significantly. Total remission is observed in 80-90% of patient, with the rest having significant improvement in sugar control.

With excessive weight loss, the skin may become saggy; hair loss may happen, especially when dietary intake is not predominantly focused on protein; and vitamin deficiency might occur if the patient does not take proper vitamin supplements that are recommended.

In short, there is marked improvement or reversal in diabetes mellitus, hypertension, hyperlipidaemia and/or obstructive sleep apnoea. There will be significant improvement in the overall quality of life and social aspects.

How is bariatric surgery effective in combating obesity?

No operation, diet or medication by itself offers a permanent cure for obesity. Bariatric surgery, together with lifestyle modification, can offer wonderful long-term results for health and weight.

It helps to accelerate weight loss, especially for those who are morbidly obese with limited mobility and are unable to perform any exercise.

How did this surgery come about as an option in the first place?

Back in the early 1950s, a patient with diabetes mellitus had undergone hemigastrectomy (partial removal of stomach). The patient’s diabetes mellitus then went into remission.

Only after about 40 years later in the 1990s, a large number of studies were published regarding bariatric surgery. Since then, more studies and newer techniques have been introduced.

Who is eligible/suitable for bariatric surgery?

Those who are obese and meet certain criteria can opt for bariatric syrgery. General recommendations in Malaysia by expert committees include the following:

• Morbid obesity without co-morbidities (without any illnesses) with BMI of more than 37.5.

• Morbid obesity with co-morbidities (such as subfertility, obesity related spine or joint problems) with BMI of more than 32.5.

• Morbid obesity with metabolic syndrome (diabetes mellitus, hypertension, central obesity, raised cholesterol level) with BMI of more than 32.5.

• Acceptable age between 18 and 65.

Under what circumstances would someone have to undergo bariatric surgery?

It is not a must-do surgery. Bariatric surgery is recommended when diet, lifestyle modification and medications fail to help a patient reduce weight and improve their medical comorbidities.

It is proven to reduce weight in those who are obese, especially those with multiple medical problems.

For those who are morbidly obese and already suffer from multiple complications and medical conditions, it is a highly recommended procedure, such as someone who has a BMI of 50 with severe osteoarthritis of the knee and is unable to move about due to pain.

For those interested in undergoing bariatric surgery, what should they expect to undergo?

They should agree for long-term follow-up after surgery, making lifestyle changes, and attending regular check-ups.

Just like any other surgery, there are risks of complications and reoperation involved, though the chances are very small. They should seek advise from their bariatric surgeon on the suitability and type of surgery as the medical and physiological needs of every individual is different.

Advantages and disadvantages of each surgery need to be discussed before decisions are made.

Will bariatric surgery help lower obesity rates in the country?

Bariatric surgery will not lower obesity rates in the country. Awareness about obesity and a healthy lifestyle is the key to lower obesity rates in the country.

Bariatric surgery will help those in need of weight loss and improve their general wellbeing and overall quality of life.

This article is courtesy of Regency Specialist Hospital, Johor.