Obesity is considered a top-priority public health emergency worldwide. Today marks the beginning of Obesity Awareness Week, and much more can be done to treat this condition. Lifestyle changes alone are not enough to halt the obesity epidemic, and surgical options are growing in popularity as the most effective treatments for long-term weight loss results. Mr Georgios Vasilikostas, Consultant General and Bariatric Surgeon at New Victoria Hospital, shares some insightful data on the most effective weight loss surgery procedures.
Obesity is a top-priority public health emergency
Obesity is regarded as a top-priority public health emergency worldwide
It is a risk factor for several diseases, such as cardiovascular conditions, joint and musculoskeletal problems, diabetes, sleep apnoea, and cancer. According to Cancer Research, obesity seems to cause 1 in 20 cancers. Obesity might also be an independent risk factor for anxiety and depression.
33% of people over 35 in England live with obesity, and its incidence tends to increase with age.
By tackling obesity, other pathologies can be prevented as well; people can improve their quality of life and live longer.
Obesity is a medical condition
According to WHO, obesity is a condition where an individual carries too much body fat mass that can put at risk their health.
Obesity depends on energy imbalance between input and expenditure.
A person is considered overweight if their Body Mass Index (BMI, the weight in kilograms divided by the square of his or her height), is over 25, and obese if it is over 30. However, this method is not very precise, and other evaluations are necessary for an accurate diagnosis of obesity.
Weight loss surgery has proved to be the most effective option in treating obesity in the long term
Bariatric surgery, commonly called weight loss surgery, refers to all surgical operations that help you lose a considerable amount of weight if you suffer from obesity.
Bariatric surgery can be much more effective than non-surgical intervention to treat obesity and its associated conditions.
Weight loss doesn’t happen with the surgery per se, but bariatric surgery is a tool to make the required diet and lifestyle changes less difficult to be achieved and maintained.
Some patients report weight loss even after ten years from surgery, whereas patients who try lifestyle changes alone tend to regain weight with time.
Surgical treatment is also a more valid option to reduce risk factors associated with obesity and improve other conditions related to excessive weight, than other medical treatments.
Some benefits that come from bariatric procedures, apart from weight-loss itself, might include:
- Remission of pre-diabetes and type 2 diabetes
- Better-functioning cardiovascular system
- Enhanced musculoskeletal health
- Reduction of sleep apnoea
- Increased longevity
- Improved fertility
A 2016 study presented at The European Obesity Summit, has shown how bariatric surgery patients have a 57% less risk of death compared to non-surgical patients.
Bariatric surgery should be considered as a viable option sooner
In the past, bariatric surgery was considered as an option only after patients had tried non-surgical treatments such as lifestyle changes, for at least a year and failed in achieving a long-term weight loss.
However, more recent approaches are pushing to make bariatric surgery available to more patients with lower BMI, in the attempt to limit the worsening of the condition and its related risks.
Today NICE guidelines in the UK are more inclusive and enable more people to be eligible for bariatric surgery.
In general, you can be an ideal candidate for weight loss surgery if
- You’ve tried many weight-loss programs, diets and lifestyle changes with unsatisfactory results
- You struggle to keep obesity-related conditions like type 2 diabetes, hypercholesterolemia, hypertension and sleep apnoea under control
- You have other cardiovascular diseases
- Your BMI is higher than 40 or between 35 and 40 with associated comorbid conditions
However, each case should be evaluated by a Bariatric Surgeon. Different criteria might be applicable, and it is important to have a Bariatric Specialist to assess your condition.
A surgical risk assessment is always necessary to limit the risk of complications during and after the procedure.
Bariatric Surgery treatments
The most common weight-loss surgeries include gastric balloon, gastric banding, which are more short-term and less invasive procedures, gastric sleeve and gastric bypass, which are more complex and long-term options.
A Gastric balloon is an endoscopic procedure where a silicone balloon is inserted in the stomach, to give you the feeling of being full sooner during a meal.
Gastric balloon is usually considered if you live with moderate to severe overweight or obesity, and it can be performed before other weight-loss or cosmetic surgeries to limit operative and postoperative risks.
It is the least invasive surgical procedure among those mentioned above. It can be performed under mild sedation or general anaesthetic, and it takes about 30 minutes to perform.
The balloon has to be removed after six to twelve months, during which time you will hopefully have acquired the correct eating habits to follow, so that once the balloon is not in your stomach anymore, the results remain stable over time.
Gastric banding is a surgical procedure to support weight loss through the application of a bandage to your stomach.
It aims to produce the same results as a gastric balloon, to make you feel full sooner.
During the operation, a silicone bandage is inserted around the upper part of your stomach to create a smaller pouch. By reducing the channel where food passes, you feel full sooner.
The laparoscopic gastric bandage is performed under a general anaesthetic, and it takes about one hour.
It is important that you apply and commit to appropriate lifestyle changes.
Laparoscopic gastric sleeve
Gastric sleeve is a procedure to reduce the size of your stomach to a tube shape.
After the procedure, the production of ghrelin, the hunger hormone, reduces conspicuously, and you will have less appetite.
You will also have to take B12 vitamin and multivitamin supplements regularly.
Gastric sleeve is a minimally invasive procedure performed laparoscopically, under sedation, and the operation takes over one hour.
Gastric bypass is a surgical procedure where part of your stomach and small bowel are bypassed, and a smaller stomach pouch is created.
The small bowel is then stitched onto this new pouch; this reduces the space for food and reregulates important hormones that control metabolism, which in turn triggers significant weight loss.
It is an option often considered if you suffer from morbid to severe obesity. It is a longer operation performed under a general anaesthetic, and it takes two to four hours.
After gastric bypass, you will have to take multivitamins, iron and calcium supplements for life.
Weight loss surgery results
Following your bariatric surgery procedure, you usually lose a great part of your weight in the first six months after the operation. Weight loss can range between 12% and 45% of your body mass weight, and up to 80% of your excess weight. However, it varies greatly from case to case.
In a 2017 study published on Jama Surgery, 35% of bariatric patients achieved a BMI lower than 30 within one year. These patients are those who had a BMI lower than 40 in the pre-operative assessment.
Results show a greater success rate for early surgical intervention as well as for long-term weight loss surgery options such as gastric bypass and gastric sleeve.
Most patients are also able to suspend medications for other conditions such as diabetes and hypertension.
Bariatric surgery risks
Bariatric surgery comes with all the standard risks associated with any type of surgery; however, laparoscopic procedures are much safer than open surgery procedures.
Death related to the operation is very rare, below 0.3%. It is more commonly associated with extremely high BMI and severe cardiovascular comorbidities.
Weight regain can be one of the specific risks, especially after gastric balloon and gastric banding procedures. However, weight regain rate is still much lower after bariatric surgery compared to non-surgical procedures.
It is important to adopt a multi-disciplinary approach and consider psychotherapy support, when needed, before and after surgery.
Discuss your options with a Bariatric Surgeon at New Victoria Hospital
Surgery options can be discussed with one of our Bariatric Specialists, who will assess your condition and needs and advise on the best surgical treatment.
If you are considering a surgical procedure, a first assessment with a Bariatric Surgeon is necessary to see if you are an acceptable candidate from a medical point of view.
Should you be suitable for a bariatric surgery treatment, you will be asked to see a dietician to agree on a pre-op and post-op diet regimen.
When necessary, the Bariatric Surgeon will suggest to seek psychological support to enhance the results of surgery and maintain them in the long-term.
Obesity Awareness Week is a reminder to take action and address obesity correctly by seeking professional help.
At New Victoria Hospital, we offer Free Mini Consultations to give you the chance to ask your questions directly to one of our Bariatric Surgeons, as well as understanding more about the available options.