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Bariatric Surgery – What You Should Know
With obesity in Australia reaching epic proportions, bariatric surgery is becoming more common to help the morbidly obese reach a healthy weight. When diet and exercise regimens have been tried and tried again with no success, sometimes surgery becomes the healthiest lifestyle choice. The decision should not be taken lightly. Individuals considering bariatric surgery should be knowledgeable about all surgical options and the risks involved.
Bariatric surgery is generally only undertaken on the morbidly obese, with a BMI of 40 and above or a BMI of 35 and above with at least one co-morbid condition. It must be assessed that the individual has tried both diet and exercise in a supervised environment with little or no success.
There are two main types of bariatric surgery performed in Australia today. These are restrictive or malabsorption procedures. Bariatric surgeons will discuss these options with patients and determine which one will best suit their weight loss needs and their lifestyle.
Restrictive Procedures
Restrictive surgery works by reducing the actual amount of food one can consume in a single sitting. Reduced food intake means reduced overall calorie/kilojoule intake and thus leads to weight loss. The benefit of restrictive procedures is that food still passes through the digestive tract in the typical order, allowing full absorption of all nutrients. Examples of restrictive procedures include;
Gastric Banding
A small inflatable rubber band is placed around a section at the top of the stomach, separating the stomach into two chambers. There is a smaller section on top and a larger one below with a narrow section (where the band is placed) separating them. When an individual eats the top section fills quickly, promoting fullness. The individual feels full for some time, as the food passes through the narrowed banded section. The band can be inflated and deflated to adjust the size of the narrow section, affecting the amount of food one can eat at each sitting.
This is the most basic form for weight loss surgery as it is completely reversible. Once a patient has lost the weight, set up healthy diet, exercise and lifestyle routines and is confident they can keep the weight off, the band can be removed.
Sleeve Gastrectomy
This surgery reduces the amount of food that can be eaten by removing a part of the stomach and leaving a banana size portion or ‘sleeve’. It is generally about 1/10th of the original stomach size. Patients lose an average of 50% of their body weight. This procedure is non-reversible.
Malabsorptive Procedures
These procedures cause food to be poorly digested, thus decreasing the absorption of nutrients. Generally the stomach size is restricted and the small intestine is bypassed to further decrease intake and absorption. These procedures have a high success rate due to the significant malabsorption. A downside is there is usually a period following surgery where the intestine adapts to the decreased ability to absorb and diarrhoea is frequent. This generally resolves but can be ongoing for some. There is a very high risk of vitamin and mineral deficiencies and lifelong supplementation is required. Abdominal bloating and gassiness is common. There is also a risk of gallstone formation.
Bilopancreatic Diversion
This involves removing approximately ¾ of the stomach. The small intestine is also divided, with one end being attached to the new stomach pouch. Food will move through this part of the small intestine with little absorption. This procedure is non-reversible.
Gastric Bypass Roux-en-Y
This procedure involves stapling the stomach into two sections, as smaller and larger pouches. The larger pouch is not removed, but is completely shut off from accepting ingested food. The small intestine is also divided, and the lower portion attached to the smaller stomach pouch. This leads to decreased absorption in the smaller length small intestine. This procedure has high success rates. Vitamin and mineral supplementation is vital with this surgery as anaemia and metabolic bone disease may occur due to the total bypassing of a large portion of the small intestine.
Along with the risks of each individual surgery, there are also the common risks of any general surgery. These risks are often confronted in patients at such high weights. Weight loss prior to surgery is often recommended and achieved with supervised very low calorie diets. An individual’s mental and emotional state should always be assessed prior to surgery. They must fully understand the permanent nature of the surgery and the impact it will have on their lifestyle, ability to eat particular foods and the amount of foods they can eat. This can be confronting post recovery.
The long term benefits of bariatric surgery rely on the individual undertaking healthy lifestyle changes. Healthy eating counselling should accompany any surgery and an exercise regimen should also begin post recovery. Bariatric surgery is not the magic key to weight loss, but it can certainly give patients a very good kick start to a much healthier lifestyle. It also reduces the future risk of developing or worsening type 2 diabetes and hypertension.
If you are considering a bariatric procedure, speak to your dietitian first to discuss all your options.
Added to site on : Monday, 19 May 2014