Fat is essential and critically important for health and longevity. But if you have more stored fat than fat utilised by the body, you can become obese.
Obesity occurs when your body has accumulated excess body fat to the extent that your health is adversely affected, and you become at risk of developing chronic diseases, including hypertension, type 2 diabetes, and heart disease.
The keys to reducing body fat are to consume fewer calories and exercise. An obese person may not achieve long-term success with these weight loss attempts. But with bariatric surgery, sustainable weight loss can be achieved.
What is Bariatric Surgery?
The term “bariatric” refers to the treatment of obesity. The field of bariatrics focuses on and treats those who have obesity by promoting weight loss. Hence, its other name is weight loss surgery. Currently, the most common procedures are gastric bypass surgery (Roux-en-Y gastric bypass) and gastric sleeve surgery (sleeve gastrectomy). Both types of bariatric procedures have demonstrated excellent long-term weight loss results.
Gastric Bypass Surgery
In gastric bypass surgery, a small stomach pouch is created by dividing the top of the stomach from the rest of the stomach. The first portion of the small intestine is divided, and the bottom end of the divided small intestine is brought up and connected to the newly created small stomach pouch.
The procedure is completed by connecting the top portion of the divided small intestine to the small intestine further down so that the stomach acids and digestive enzymes from the bypassed stomach and first portion of the small intestine (duodenum) will eventually mix the food.
Gastric bypass surgery addresses weight loss through the following mechanisms:
- The created stomach pouch is considerably smaller than the original stomach. Therefore, the patient experiences early satiety (feeling of fullness after a meal), translating into fewer calories consumed.
- Due to the exclusion of a length of upper small intestines, only a percentage of the ingested volume of food is absorbed, further reducing the number of effective calories the body uses.
- Rerouting the gut produces gut hormone changes that promote fullness, suppress hunger, and reverse one of the primary mechanisms by which obesity leads to type 2 diabetes.
Gastric bypass surgery can be done in two ways: open surgery or laparoscopy. Open surgery requires a large surgical cut to open your belly, while in laparoscopy, the surgeon uses a laparoscope (tiny camera) to see the inside of your abdomen.
Gastric Sleeve Surgery
Gastric sleeve surgery is another type of weight loss surgery. It restricts your food intake, which leads to weight loss (approximately 20 to 40 kilograms depending on the original weight). It is the most common weight loss procedure in Singapore due to its high weight loss and low surgical risk profile.
Gastric sleeve surgery is different from gastric bypass. In gastric bypass, the surgeon makes a small pouch that skips most of your stomach, going straight to the intestine.
In gastric sleeve surgery, the surgeon makes small cuts in your belly and inserts a laparoscope. The surgeon then inserts other medical instruments and removes three-quarters of your stomach to form the “sleeve” or tube.
Who is eligible for Bariatric Surgery?
Candidates for bariatric surgery must have:
- A body mass index of 37.5 kg/m2 and above (very severe obesity) OR
- A body mass index of 32.5 to 37.4 kg/m2 (severe obesity) and a serious weight-related health problem, such as type 2 diabetes, high blood pressure, or severe sleep apnea.
Discuss with a trusted weight loss surgeon to check if you are eligible.
What You Can Expect from Bariatric Surgery?
The benefits of bariatric surgery go beyond weight loss. Here are some additional benefits as described by the Cleveland Clinic’s Health Essentials:
- Long-term remission for type 2 diabetes – Studies have shown that bariatric surgery results in improvement or resolution of type 2 diabetes in more than 70% of these patients. Around 30% of the patients maintained the remission after 15 years. They also had fewer complications associated with diabetes than those receiving usual diabetes care.
- Improved cardiovascular health – Weight loss surgery decreases a person’s risk of heart attack, stroke, and peripheral vascular disease.
- Relief of depression – Difficulties with body image, social stigma, and self-esteem can cause feelings of depression and isolation for many obese people, young people included. Bariatric surgery can contribute to decreases in depression both at the time of and several months after surgery.
- Improve obstructive sleep apnoea – The weight loss facilitated by bariatric surgery is useful in treating sleep apnoea. Approximately 80% to 85% of patients experience remission a year after surgery. Often, through reaching and maintaining a healthy weight range, patients with sleep apnoea can avoid using a CPAP machine nightly.
- Joint pain relief – Obesity can strain joints severely. Weight loss through bariatric surgery can reduce the joint damage and chronic pain caused by excess weight, thus lessening the need for pain medication and enhancing the patient’s mobility.
- Improve fertility – Weight loss surgery can help restore ovulatory function and regulate menstruation in women who do not ovulate, and may also reduce miscarriage risk.
- Reduce the risk of obesity-associated cancer – A large Cleveland Clinic study shows that among adults with obesity, weight loss achieved with bariatric surgery was associated with a 30-40% lower risk of developing cancer and cancer-related death compared with adults who did not have the surgery.
There are many practical options to lose excessive weight, but not all are achievable and sustainable. As part of a multi-disciplinary approach, gastric bypass and gastric sleeve surgery provide sustained relief for overweight people, making them highly effective weight loss methods.