Breaking down Bariatric surgery
Surgery for weight loss has become an increasingly common solution to the rising incidence of obesity. But, as with any procedure, a patient exploring bariatric surgery has a number of options to consider. Goodness Me looks at who bariatric surgery might suit, what is involved and what to expect a typical day’s meals to look like post-surgery.
Bariatric surgery, more commonly known as weight loss surgery, refers to any surgery designed to reduce weight and improve metabolic health. Bariatric surgery may be recommended for people who have a very high body mass index (BMI) — over 35 or 40 — and often related health disorders, such as diabetes, high cholesterol, high blood pressure or fatty liver disease. Some people with psychological issues related to their weight may also be considered, provided they are in the high BMI category as well.
According to Dr Michael Hii, Epworth oesophago-gastric and bariatric surgeon, it is not uncommon for a person to seek a referral for bariatric surgery after seeing the results on a friend or family member.
“We tend to find that most people have done a fair bit of research by the time they see a surgeon,” Michael says.
He says that the initial appointment and follow-up appointments involve a thorough health assessment.
“The surgery itself is just a tool. Patients still need to make the necessary lifestyle changes such as dietary, exercise and psychological commitments and be fit enough for the surgery. We run a number of tests to ensure it is safe,” he says.
Michael says most people who are referred for surgery have a serious amount of weight to lose, which would be almost impossible to achieve through traditional diet and exercise methods.
“Once you get to a very high weight, you can’t simply eat less and exercise more to lose it. There are many biological and probably permanent changes in your body’s metabolism that make it very difficult to achieve medium and long-term weight loss,” he says.
“Bariatric surgery can be used as a means to partially ‘reset’ the body’s metabolism, but it is also incumbent on the patient to commit to the dramatic change in food intake that is required after surgery.”
The three main types of bariatric surgery available are:
- gastric sleeving
- gastric banding
- gastric bypass.
A gastric sleeve is now the most common form of bariatric surgery, and involves reducing the size of the stomach and converting it into a sausage-shaped tube.
“Gastric sleeving dramatically reduces the amount of food you can fit into your stomach. It is keyhole surgery and involves a two- to three-day hospital stay. It is not a particularly invasive procedure, and suitable for the majority of people looking for dramatic weight loss in the short to medium term.”
Gastric banding involves putting a silicone band — like a belt — around the top of the stomach. It interacts with the way your brain receives messages about hunger and restricts your food intake.
The gastric band, which was one of the first of the bariatric surgery options to gain traction in Victoria, has lost popularity since the development of the gastric sleeve, which is now the more common of the two.
Gastric bypass is perhaps the most complicated of the options, and involves dividing the stomach to create a small pouch connected directly to the small intestine to bypass the lower stomach.
In general, the more invasive the operation, the greater the weight loss outcome will be, according to Michael, but it is also important to consider that more invasive procedures carry higher risks.
“With that being said, each type of bariatric surgery generally results in significant weight loss. Each option works to alter the function of the stomach and reduce the severity of other obesity-related conditions such as diabetes, high blood pressure and fatty liver disease.”
Michael says it is vital that patients engage in post-surgery follow up, to help with the ongoing management of diet, psychological wellbeing and exercise.
When it comes to diet after surgery, there will initially be a drastic reduction in the amount of food that can be consumed. A typical day’s meals may include one Weetbix with milk and fruit at breakfast, half a sandwich for lunch, and a small piece of meat and salad or vegetables at dinner.
Michael says patients tend to slowly increase their portion size over time.
“At around 18 months post-surgery a patient might be eating an entrée-sized meal at a restaurant.”
Michael says that while highlighting the importance of healthy weight management is key, for people who already have a high BMI weight loss surgery can present a helpful option.
“Bariatric surgery is one of the safest and most effective options for weight loss, improving the quality of life in cases where diet and exercise have not been effective enough in achieving optimal health.”
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