Obesity is a serious health issue that affects millions of people worldwide. It is a condition in which a person has an excessive amount of body fat, which can lead to numerous health problems, including diabetes, heart disease, high blood pressure, and certain types of cancer. The degree and severity of obesity are determined by Body Mass Index BMI which is calculated depending on the gender, age, weight, and height of the patient. While lifestyle changes, such as diet and exercise, can help to manage obesity, in some cases, surgery may be the best option.
Obesity treatments are primarily assessed by endocrinologists, dieticians, psychiatrists, and exercise consultants. Moreover, selected patients are also referred to our General Surgeons who are experienced in obesity surgery. All patients are assessed in detail for underlying factors of obesity, eating habits, psychology, and health status. An appropriate treatment program is planned for the patient depending on these assessments. This treatment program may include medical and surgical treatment options as well as medical nutrition and exercise, depending on the patient’s needs.
Diet Therapy aims to make patients lose weight under the supervision of nutrition and diet experts. Here, a calorie-specific diet is planned for each patient according to eating patterns and health status. Patients are followed up by nutrition experts throughout the program.
Patients who are under obesity treatment generally face health problems while exercising, for example, problems in the knee joint due to excessive loads. These problems cause the patient to abandon exercising and resulting in further weight gain. Physicians and physiotherapists plan a program that covers exercises, which fit the health status of the person, such as swimming and water gymnastics. Doing exercise for 45 minutes a day for three days a week can even be effective in weight loss.
Patients are recommended to make changes in their lifestyles such as using public transportation instead of driving all the time and making plans that focus on sports activities, such as nature hikes on weekends instead of dining out.
Doctors may prescribe medication treatment to eliminate metabolic problems that may lead to weight gain in patients. There is no FDA-approved safe and effective drug that can be prescribed for the treatment of obesity.
Obesity surgery, also known as bariatric surgery, is a type of surgery that is performed to help people who are severely obese lose weight. Obesity surgery is recommended for patients with a BMI value over 35 who cannot lose weight with other methods, a such as medical diet under the supervision of a specialist, exercise, and medical treatment. Moreover, it is recommended for patients with a body mass index over 30 who have problems that affect their quality of life and life expectancies, such as hypertension, diabetes, and sleep apnea.
There are several different types of obesity surgery and procedures, each of which works in a slightly different way. The best surgical technique is determined by doctors in the light of various examinations and tests.
We will discuss some of the most common types of obesity surgery or procedures, their benefits, and their risks.
One of the following operations has been approved:
- Stomach Botox
- Stomach balloon
- Swallowable gastric balloon
- Gastric sleeve
- Gastric bypass
- Adjustable Gastric Banding
Stomach Botox Injection:
It is a simple, non-surgical, one-day procedure (without hospitalization) Performed by endoscopy where Botox (botulinum toxin) is injected into the stomach wall. Botox temporarily relaxes the muscles and slows stomach emptying, causing loss of appetite and reducing the desire to eat. It may be appropriate for people with moderate weight loss goals, and it typically leads to a loss of 5% to 10% of body weight. It is a temporary process that leads to a slight weight loss. The effect of the injection lasts about three months, and its repeatable if needed every six months.
Preparing for an Endoscopic Botox Gastric Injection may include not eating and drinking for a certain period before the procedure. The procedure takes place in an endoscopy center, and the injections take about 10 minutes. The doctors give you sedating medication to make you sleepy then insert an endoscope, a flexible tube with a light and a camera, into your mouth and down your throat into the stomach and inject botulinum toxin in several spots around the bottom of the stomach. Once the sedation wears off, you can go home. You will need someone to drive you as you may still be drowsy. In about a week to 10 days after the procedure, you will notice that you are less hungry, become full faster when eating, and are able to feel satisfied with less food. Botulinum toxin injections in the stomach are safe for those who do not have muscle problems and who are not allergic to botulinum toxin. The injections may result in a very small amount of bleeding inside the stomach. Most people have little to no side effects. After the procedure your doctors will suggest; eating slowly to avoid stomach discomfort, chewing your food thoroughly, and stopping when you feel full.
Stomach balloon:
The medical gastric balloon, a soft, smooth, durable balloon made of silicone rubber is implanted endoscopically inside the stomach cavity. The balloon fills a large part of the stomach space, which leads to a quick fullness feeling and inability to eat large quantities of food, which leads to moderate weight loss. The balloon is also a temporary procedure where the balloon can be removed after six months or a year depending on the need.
It is a minimally invasive, outpatient procedure that takes about 15 to 20 minutes and is performed in an endoscopy center. You will be sedated, so you are very sleepy and comfortable. Once you are under sedation, you lie on your side while the doctor performs the procedure. To place the balloon in the stomach, the doctor uses a flexible, narrow tube-like camera device, equipped with lights, that is called an endoscope. The doctor inserts the endoscope into the mouth and carefully examines your esophagus, stomach, and small bowel to ensure there is nothing that would make having a gastric balloon unsafe, such as a large hiatal hernia or stomach ulcer. If everything looks normal, the doctor will insert the balloon and withdraws the endoscope, leaving the filled balloon behind in the stomach. You will be able to go home as soon as the sedation wears off. Make sure someone can drive you.
You may experience some nausea, vomiting, or stomach cramping for a few days after the procedure. Your doctor will prescribe medications to help with these symptoms, which tend to go away in three to five days. In the first two weeks after gastric balloon insertion, you will be on a liquid diet, followed by a gradual transition to regular food. You can resume all your normal activities without limitations, including showering, swimming, and traveling by plane.
Very rare complications from the gastric balloon include; Balloon deflation, which can cause the balloon to move out of the stomach and block the intestines, Perforation of the esophagus or stomach following balloon placement, Spontaneous over-inflation of the balloon after placement due to unknown causes, requiring early removal.
You are likely to lose weight quickly, especially in the first three to four months of living with the gastric balloon. Typically, people lose about 10 to 15% of their body weight by the time the six-month program is complete.
When you have completed the treatment program or when your doctor recommends, the balloon can be removed. This is a simple procedure that takes about 20 minutes and follows similar steps to the placement of the balloon. To remove a gastric balloon, the doctor will sedate you to make you comfortable then insert an endoscope into your stomach through the mouth to retrieve the balloon.
Long-term dietician and behavioral or medical therapy to support a healthy diet and exercise habits are recommended to prevent you from regaining weight after the balloon is taken out.
Swallowable gastric balloon
The modern self-dissolving balloon is a pill balloon capsule, which is swallowed under the guidance of a doctor without anesthesia or endoscopy. The placement takes place during a 15-minute outpatient visit. Simply swallow a capsule containing the deflated Balloon with a catheter: once the Balloon is confirmed to be in your stomach via x-ray, the Balloon is filled with water through the catheter. A second x-ray takes place to ensure the Balloon is filled correctly. No need to do an operation to remove the balloon, as after approximately 16 weeks, the Balloon deflates and passes naturally. In very rare cases, an intervention might be required.
Gastric sleeve:
It is a surgical operation in which 70-80% of the stomach is removed and the other part of the stomach remains, preserving the physiological functions of the stomach, which reduces the complications of surgical work and nutritional deficiency. This creates a smaller stomach pouch that limits the amount of food a person can eat. This operation limits the only volume of food intake; since nutrients are absorbed in the usual way, patients do not need vitamin or mineral supplements. The surgery is usually performed laparoscopically, which reduces the recovery time. The Sleeve operation is used in cases of moderate and severe obesity. Weight-loss surgery isn’t advised for people who abuse medicines or alcohol, or who are not able to commit to a lifelong change in diet and exercise habits.
Before the surgery, you’ll need to enroll in a bariatric surgery education program. This will help you get ready for surgery, and life after surgery. You’ll have nutritional counseling and a psychological evaluation. If you smoke, you will need to stop for several months before surgery. You must stop taking aspirin, and other blood-thinning medicines in the days before your surgery. You shouldn’t eat or drink anything after midnight before surgery. You will get physical exams and blood tests and imaging studies of your stomach or have an upper endoscopy before surgery.
Under general anesthesia, your surgeon will use laparoscopy. Several small incisions in your abdomen will be done. The surgeon will then insert a laparoscope and put small surgery tools into these incisions. The surgeon will then use a laparoscopic stapler to divide the stomach, leaving a narrowed vertical-sleeved stomach. The part of the stomach that was removed is then taken out of the abdomen through an incision. Your surgeon may then test for any leaks in the sleeve using a dye study or an upper endoscopy.
You will hospitalize 3 days after surgery. You will be on a liquid diet for the first weeks. Your surgery team will give you a schedule of types of meals over the next weeks. You’ll go from liquids to pureed foods, then soft foods, and then to regular food. Each meal needs to be very small. You should make sure to eat slowly and chew each bite well. Don’t move too quickly to regular food. This can cause pain and vomiting. You may need to take a daily multivitamin, plus a calcium-vitamin D supplement. You may need additional nutrients, such as vitamin B-12 or iron. You’ll need to have regular blood tests every few months in the year after surgery. This is to make sure you don’t have low blood iron (anemia), high blood glucose, or low calcium or vitamin D levels. If you have heartburn, you may need medicine to reduce stomach acid.
The benefits of sleeve gastrectomy include significant weight loss, improved diabetes control, and a reduced risk of heart disease. However, the surgery does carry some risks, such as bleeding, infection, and the possibility of leaks from the newly created stomach. After losing weight, it’s possible to regain some of the weight that you lose. The sleeve may widen (dilate) over time. This will let you eat more. To avoid this, make sure to follow a healthy diet and get regular exercise.
Gastric bypass (Roux-en-Y):
This process bypasses the stomach and part of the small intestine, and the stomach loses its full function. This process leads to severe weight loss. It works by creating a small stomach pouch and rerouting the small intestine to that pouch. This limits the amount of food that a person can eat and reduces the absorption of calories and nutrients from the food. We resort to this procedure in severe obesity cases.
Before the surgery, you’ll need to enroll in a bariatric surgery education program. This will help you get ready for surgery, and life after surgery. You’ll have nutritional counseling and a psychological evaluation. If you smoke, you will need to stop for several months before surgery. You must stop taking aspirin, and other blood-thinning medicines in the days before your surgery. You shouldn’t eat or drink anything after midnight before surgery. You will get physical exams and blood tests and imaging studies of your stomach or have an upper endoscopy before surgery.
The surgery usually takes several hours. You will have general anesthesia for your surgery. Through several small incisions in your abdomen, the surgeon will then insert a laparoscope and put small surgery tools into these incisions. The surgeon will use a laparoscopic stapler to make a small stomach pouch with the upper part of your stomach then uses the stapler to divide the upper part of your small intestine into a tube with two ends. One end of the small intestine (the Roux limb) is brought up to the stomach pouch, and a small connection (anastomosis) is made between them. The other end of the small intestine is then connected to another part of the small intestine. Then your surgeon may test for leaks with a dye study or an upper endoscopy.
You may stay in the hospital for 3 days after the surgery. You will likely only have liquids for the first weeks after surgery. Your doctor may slowly add soft food and then regular food to your diet about a month after surgery. You will need to chew slowly and fully, and not drink 30 minutes before or after you eat. Your doctor will prescribe vitamin and mineral supplements that your body may no longer absorb well from food alone.
To prevent nutritional problems after gastric bypass surgery, many doctors advise: Daily multivitamins, calcium supplements, vitamin D, Vitamin B-12 supplements, Iron supplements, and vitamin C. Because nutritional deficiencies can happen after gastric bypass, doctors recommend regular blood tests. Body aches, dry skin, mood changes, hair thinning, tiredness, and coldness can occur during the weight lose period temporarily until your weight will stabilize. Weight loss continues for about a year, and then will stop.
After a year, you may be able to eat more if the pouch stretches. You should use the first year to develop good eating and exercise habits that will keep you from regaining weight. Along with follow-up appointments with your doctor and surgeon, you will likely see a dietitian who will teach you how and what to eat with your reduced stomach size. You may also need to see a psychologist to help you deal with the feelings and concerns over your changed lifestyle.
Despite the complications of the operation such as nutritional deficiencies and vitamins which can be corrected by medications, it is 100% reliable if performed correctly by an expert surgeon to reduce weight to the ideal weight within a short period and it’s currently being performed by endoscopy, which means that only small incisions are made in the abdomen, reducing the recovery time. The benefits of gastric bypass surgery include significant weight loss, improved diabetes control, lower blood pressure, and a reduced risk of heart disease. However, the surgery does carry some risks, such as bleeding, infection, and blood clots.
Adjustable Gastric Banding
Adjustable gastric banding is a type of obesity surgery that involves placing a band around the upper part of the stomach, creating a small stomach pouch. The band can be adjusted over time, which allows for less food to be eaten. The surgery is usually performed laparoscopically, which reduces the recovery time.
The benefits of adjustable gastric banding include significant weight loss, improved diabetes control, and a reduced risk of heart disease. However, the surgery does carry some risks, such as band slippage or erosion, and the possibility of the band needing to be removed or replaced.
Conclusion
Obesity surgery can be a life-changing procedure for people who are severely obese and have not been able to lose weight through other means. The surgery can lead to significant weight loss, improved health outcomes, and an overall better quality of life. However, like any surgery, it does carry some risks, and it is important to discuss the potential benefits and risks with a qualified healthcare provider.
Ultimately, the decision to undergo obesity surgery should be made after careful consideration and consultation with a healthcare provider. It is important to remember that obesity surgery is not a magic cure for obesity, and lifestyle changes, such as diet and exercise, is still necessary to maintain a healthy weight in the long term.
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