What is morbid obesity? It is a chronic illness in which too much weight or fat excesses are associated with an increased risk of certain illnesses which reduce life expectancy. These illnesses are type ll diabetes, mellitus OSAHS , HTA, DYSLIPIDAEMIA, gout, arthritis in the knees and feet, varicose veins, gallstones, urinary incontinence or infertility.
Are operations possible? Yes, these days it is accepted that obesity surgery is the only treatment with proven long-term weight loss in severely obese patients. It becomes applicable for those who have had several medical attempts and who have a BMI of more than 35 or 40 and if a positive benefit in relation to the serious illnesses mentioned above can materialise after significant weight loss
When do you have morbid obesity? When we have a (Body Mass Index) BMI greater than 40. BMI is an estimation of body fat percentage which is calculated by dividing the weight (in kilo) by the height (in metres) squared. Although the exact figures are not known by the WHO, it is estimated that in Spain it is around 0.4% in men and 0.7% in women.
Therefore, the objectives of bariatric surgery are:
- Decreasing and maintaining body weight
- Decreasing co-morbidities/illnesses associated with obesity
- Improving quality of life.
How is the operation and what are the advantages? It is done laparoscopically. The patient only has small incisions which allows for the quickest recovery with little pain and early mobilisation. The reintroduction of an oral diet allows the patient to return home quickly and resume normal activities.
What techniques are used? In brief, there are two technique types:
a) Restrictive: based on reducing gastric capacity and therefore helping early and lasting satiety.
- Gastric band and the tubular sleeve gastrostomy.
b) Mixed: This involves stomach intervention, reducing its capacity and that of the intestine, reducing food absorption. This includes:
- Biliary-pancreatic bypass
- Gastric Bypass
What is most commonly performed? It depends on each patient: your BMI, your eating habits and associated diseases. As an example: In a patient with BMI <40 kg/m2 a gastric sleeve can be a good choice. For higher BMIs or diseases such as type ll diabetes or those with “nibbling” habits, a mix is recommended.
Are there risks with surgery? Complications are rare, much less than with other abdominal surgeries. It is much more dangerous not to have surgery than to have uncontrolled high weight since the associated diseases have a higher mortality rate. Complications are below 5% and the mortality is very low (<1%) compared to the morbidity and mortality associated with obesity (<1%). Note that these percentages refer to properly equipped purpose built centres and when performed in carefully selected patients and followed by proper multi-disciplined post-operative care as offered by Salud-10.
How much weight is lost? It is difficult to predict how much weight a person will lose because it depends on several factors, some controllable, such as food, and others which cannot be controlled (genetics, sex). In general, you lose 30-50% of the initial weight. Most of the weight (66%) is lost during the first 6 months. The rest of the weight is lost within 6-18 months of surgery.
Can the lost weight be regained? Normally within 2 years of surgery a small weight gain occurs (between 5-10kg) as a result of stomach “dilation” – there is room for more food. This does not mean that the weight gain will continue unless the patient deviates from the dietary recommendations and persists with a sedentary attitude, in which case much of the lost weight will be regained. In Salud10 we differ by the accompaniment of patients in their post-operative rehabilitation process and control of food habits and impulses is a fundamental part of our program.
What are the benefits? The benefits are derived from the weight loss and long term management. It is really amazing how most of the complications associated with obesity improve after a few months of weight loss.
These are the main benefits:
• Most people with diabetes stop taking insulin and it is controlled by diet only or with the help of an oral anti-diabetic, including the week after the surgery.
• Almost all patients with sleep apnoea and those who use a breathing apparatus at night (CPAP), quit it completely.
• Arterial pressure figures improve spectacularly with 50% of patients not needing medication.
• Osteoarthritis related pain is relieved rapidly. The joint defects caused by excess weight cannot be fixed
• Improved figures for cholesterol, uric acid, transaminase, etc.
• You become more comfortable when performing daily tasks, both personal and work related.
• You can start exercising and doing sports that were not previously possible (including during sex).
• Increased self-esteem, reduced depression symptoms and improved relationships with others.
• In addition, improved quality of life!
What type of food is prescribed after surgery?
The dietary aims are focussed on the following:
- Weight-loss promotion
- Prevention of complications
- Ensure an adequate diet
- Nutritional deficiency avoidance.
Thus, in the first months after surgery, the diet progresses as follows: 2-3 weeks with a protein rich liquid diet / 2-3 weeks with purees / after this, solid foods are introduced
Can you eat anything once the solid phase is reached?
As a general rule, you should always take care with food because no method allows you to eat anything in the desired quantities, without gaining weight. Therefore, it is necessary to follow a healthy and balanced diet, low in calories and fat. This means:
- Maintaining good hydration and regular physical activity
- Ensuring good vitamin supplementation
- Taking small meals spread over 5/6 sittings per day
- Avoiding fried food and control the daily consumption of oil
- Avoiding sweets, sugared drinks and foods rich in fats
- A diet rich in fruit, vegetables, lean meats, fish and low fat dairy products