What does bariatric treatment mean?
Branch of medicine dealing with the cause, complications and treatment of obesity is termed as bariatrics. It is a part of gastroenterologic diseases/conditions limited to the stomach and small intestine for the correction. The basic metabolic rate known as BMR in obese individuals in extremely low causing a decrease in the digestive ability, reduced fat/calories burning and thus, increase in fat deposition. Bariatric surgery is a recent trend in the surgical approach for the treatment of obese conditions. We make our readers familiar with all the pros and cons of it in the following description.
Causes of obesity:
- Lethargic/sedentary lifestyle: This maybe due to the type of occupation or the working hours at job, confined to one place glued to electronic devices. Excessive consumption of alcohol also adds to it.
- Lack of physical activity: This again maybe due to lack of interest/motivation for physical exercises, outdoor games along with increased appetite.
- Genetics: In some cases, obesity occurs as a result of extremely slow metabolic rate occurring in the family which eventually is transmitted to the off-springs.
- Medications: Certain medications such as anti-depressants, corticosteroids, anti-epilepsy cause retention of fluids in the body leading to swelling. This however is not the cause of obesity in true sense and can be managed without surgical intervention.
- Obesity: may also occur secondary to hypothyroidism, cushing’s syndrome and polycystic ovarian disorders PCOD owing to an imbalance in the hormonal levels.
Signs & Symptoms of Obesity:
- Lack of interest in physical exercises, visible fatty and chubby appearance
- Rise in breathlessness, lethargy
- Increased heart rate, blood pressure, palpitations, increase blood sugar level, frequent headaches.
- Increased body mass index BMI, body weight and reduced basic metabolic rate.
Classification of obesity:
Obesity is generally classified on the basis of body mass index BMI. It is a value obtained by dividing the weight of the individual in kilograms by the height in meters and gives the value in kg/m2
1. Value below 18.5: underweight
2. Value 18.5 to 25: normal
3. Value 25 to 30: obese
4. Value 30to 35: class I obese
5. Value 35 to 40: Class II obese
Class I and II individuals are the ideal candidates for a bariatric surgery, when all the diet monitoring and exercise motivation fails to reduce obesity. This approach involves reducing the appetite and increasing the hunger fullness by working upon the stomach and small intestine.
In addition to this, tests to check cardiovascular signs such as increased pulse rate, blood pressure, palpitations and blood sugar levels also help in diagnosing obesity.
Treatment of obesity using bariatric surgery:
Bariatric surgery is one treatment protocol which ligates/cuts/bypasses the stomach in an invasive manner to help reduce obesity. Diagnostic tests required prior to it include:
- Body mass index confirming class I and II values
- Blood test with a complete blood count CBC, heamoglobin level, ruling out any blood pathology.
- Thyroid function tests: For the evaluation of hormonal balance
- Ultrasound of gastric region for the condition of stomach and small intestinal curvature.
- Upper GIT endoscopy may also be required.
1. What does bariatric surgery do?
This innovative surgical modality reduces the appetite by reducing the size of the stomach. As a result, the satiety centre in the hypothalamus feels full soon and the patient does not feel like eating more. The upper part of stomach may be ligated, stapled or cut in order to hinder the passage of food. A major part of body of stomach maybe also removed for the same purpose. In extreme cases, stomach may also be bypassed and food poured into the ligated small intestine directly.
2. Types of Bariatric surgery:
- Laparascopic approach: A gastric band or ring is inserted and placed on the upper part of stomach. It has an inflatable part which opens like a balloon or a sac soon after the patient starts eating. As a result, stomach feels full and the patient stops eating.
- The patient may require multiple visits to the surgeon after the procedure has been completed and undergo series of chest xrays and USGs to make sure the band is in place and working effectively. It is a reversible process, band maybe removed if not found effective.
- Use of gastric sleeves: In this approach, the fundus and body of the stomach are permanently removed leaving behind only a C shaped curve of the stomach. Since the size of the stomach is drastically reduced, it has the capacity of holding very little food. It is an irreversible process and should be planned appropriately.
- Gastric bypass/Roux-en-Y bypass: In the first step, the lower part of the stomach is entirely stapled and only a part of the upper stomach receives food. In the next step, the upper curvature of the small intestine is resected and the lower portion is directly attached to the upper part of stomach.
- The digestive juices are directly poured from the upper part of stomach to the lower part of intestine. Thus in a way a part of both stomach and small intestine are bypassed and appetite reduced. It is an irreversible procedure, however complications chances are less.
- Duodenal switch: It is a complex approach, requiring two different surgeries. The first involves the gastric sleeve approach where a major part of stomach is removed. In the second part of surgery, major portion of small intestine is removed and the remaining part ligated to the upper part of the stomach.
It is the most complicated of all surgical approaches and requires a proper planning and execution.
Complications & risk factors associated with bariatric surgery:
- Gastric band/ring position may get altered/disturbed in some cases. This however is not a complication, the only drawback being the cumbersome surgical approach that may have to be repeated again.
- Indigestion/diarrhea/nausea: It occurs due to leakage of digestive/gastric juices. Also the gut bacteria get killed as a result of which digestion process may get delayed/hampered. Abdominal pain, fever due to recurrent infections may also be encountered.
- Non healing ulcers may develop in the gastric and intestinal region due to lack of vitamin C post surgery. The bacteria required for vitamin c absorption becomes less and hence persistent ulcers are seen.
- Excessive/unwanted weight loss: It may occur due faulty absorption of nutrients from food owing to missing/depleted gut bacteria which when present in normal conditions help in the absorption of nutrients.
Success Rate of in India:.
Weight loss following a bariatric surgical approach requires a long term monitoring along with diet modification and exercise motivation. Almost 88.89 percent of cases fail to gain weight post surgery and have great chances of maintaining the same weight without any complications for almost a period of 15-18 years.
Team MedcureIndia has been striving ever since its establishment towards the well being of its clients. Be it the diagnosis or the selection of treatment modality of any disease, we believe in exposing our clients to the most appropriate one in our knowledge. We also firmly believe in enhancing our status regarding the recent treatment trends, bariatric surgery being one of them. The topmost hospitals offering this procedure are places where we direct out clients, assuring treatment results best suited for them.