Life & Style | Health

Bariatric surgery: There’s help for the obese

Bariatric surgery methods in the UAE offer hope for the extremely overweight

  • By Mahmood Saberi, Senior Reporter
  • Published: 07:00 June 13, 2013
  • Gulf News

  • Image Credit: Clint Egbert/Gulf News
  • From left: Ajay Chaturvedi, Marketing Manager for International Modern Hospital; Shanon Salem Al Harthi; Mythily Anandhy; Allicia Michele; Dr. Girish Juneja, Director of Bariatric Center; Audrey Zhen Gonzales; Aaron Dann Gegajo and Mohamed Seoudi.

Dubai: The figures are alarming.

A large number (30 per cent) of school-going children in the UAE are obese and 70 per cent of women and 60 per cent of men are overweight.

These numbers were pointed out by a surgeon to highlight the growing dangers of obesity in the country.

“It not only affects your health but your lifespan too,” says Dr Girish Juneja, Head of Bariatric Surgery at International Modern Hospital, Dubai.

Being overweight or obese is a major risk factor for other complications such as heart disease, diabetes, hypertension (high blood pressure) and cancer.

Obesity or being overweight occurs over a period of time when you eat more calories than you can use. But the balance between calories in and calories out differs from person to person.

The factors that can tilt the balance are your genetic makeup, whether you eat high-fat foods, over-eat and whether you exercise or not.

You can use a measurement tool called the Body Mass Index (BMI) to know whether you are obese, overweight or under weight. BMI compares your height to your weight. It is done by dividing your weight by your height squared.

An example is:

82 kgs/ 1.83 m x 1.83 m = 24.5

A BMI of less than 18 means you are under weight

A BMI between 20 and 25 indicates you are at a healthy weight.

A BMI between 25 and 30 suggests you are overweight.

A BMI of 30 or more indicates obesity and you will have to consult a doctor to start losing weight.

There are many ways of reducing weight, the most traditional being exercise and lifestyle modifications but as time and history have proved, most people beg off this and prefer quick methods. Dieting has been a rage for centuries but its pitfalls are legion by now. Weightloss medicines too have taken a bad rap due to their side effects and scientifically unproven claims.

“To date, non-surgical treatments such as dieting or medications have not been very effective,” says Dr Juneja, who introduced a number of patients who had undergone bariatric surgery to reduce their weight. Bariartic surgery has been sought after in the recent years by many people suffering from obesity due to various causes. The surgery involves reducing the size of the stomach through various procedures so that you eat less amount of food.

But, having said that, bariatric (weight-loss) surgery is not for everyone. It is only recommended if you are BMI is 35 and you have co-morbidities such as diabetes and high BP. This type of surgery helps reduce weight and also resolves various conditions associated with over-weight such as joint pains and dyslipidemia, a condition in there are high amounts of lipids (cholesterol) in the blood.

“Many scientific studies have been done to show that bariatric surgery is more reliable and successful [than medical therapy]),” says Dr Juneja. “There is now a shift in the perception of bariatric surgery, which is not only recommended for weight loss but also for cure and improvement of associated diseases with obesity,” he says.

Basically, what bariatric surgery does it to change the anatomy of your disgestive system to limit the amount of food that you can eat and digest.

These surgeries are done by laparoscopy or key-hole surgery through 0.5cm-1cm holes in the abdomen.

A tiny video camera is inserted through the small incision allowing the surgeon to perform this minimally invasive type of surgery.

The laparoscope is a small tube that consists of a light source and a camera and relays the images inside on to a TV screen. Laparoscopies are also used to carry out surgical procedures and small devices, such as lasers, can be passed through the holes in the skin.

The advantages of laparoscopic surgery is that it is more precise and safe, leads to little post-operative pain and offers faster recovery than open surgery.

But this surgery is the last resort. The need of the moment is prevention rather than cure. The change, believes Dr Juneja, must begin in childhood. “We have to start with the children and teach them lifestyle changes so that they develop into healthy adults,” he says. He recalls a time recently when he had to perform a bariartic surgery on a 16-year-old. This, he believes, should not become the norm. Lifestyle modifications such as eating nutritious foods and leading an active life, need to be as mandatory to an individual’s health as brushing one’s teeth. Compromising one’s health is not an option.

“Diabetes is curable”

“The numbers of diabetes patients are on the increase,” says Dr Padma Kumar, specialist general surgeon in the diabetic and bariatric surgery team, International Modern Hospital, Dubai.

Asians, according to him, have a high incidence of diabetes due to their genetic make-up and this affliction is more deadly than cancer as it affects all organs of the body from the eye to the toe.

Such people are at risk of heart attack, stroke and kidney disease. Eye complications can lead to blindness and poor circulation can lead to amputation of the limb.

The surgical procedure offered is the Modified Sleeve Gastrectomy and Ileal Interposition. Through key-hole surgery, the stomach’s size is reduced so that the food intake is limited. The last length of the small intestine is brought towards the stomach that helps bring the partially digested food into the small intestine rapidly.

“This helps increase the GLP1 (a hormone) levels that increases insulin levels,” says Dr Kumar.

These two procedures are done together.

“Patients are amazed as the results are immediate,” he says. “The blood sugar levels drop even after eating food as the GLP1 helps produce good amount of insulin,” he says.

This surgery, offers long-term solution to diabetes. But not everyone can undergo this procedure; there are certain conditions such as the patient’s pancreas should be capable of producing good levels of insulin and that there should not be any anti-bodies, which can hamper production of insulin.

This type of surgery will require between 3 to 5 days stay in the hospital and a visit to the doctor every 3 months for check-ups.

Fact Box

Leading institutions in the UAE offering Bariatric Surgery:

 

Shaikh Khalifa Medical City, Abu Dhabi.

Rashid Hospital, Dubai.

Al Qassimi Hospital, Sharjah.

Rashid Centre for Diabetes and Research, Ajman.

 

Surgery Cost (These are estimates only).

 

Sleeve Gastrectomy: Dh 40,000

Gastric Bypass: Dh50,000

Gastric Band: Dh 25,000

Gastric Balloon: Dh 12,000

 

Gastric banding

Emirati Shannon Al Harithi was not only obese but was diabetic and had high blood pressure before he underwent a gastric banding procedure.

“I feel great,” says the 33-year-old who earlier weighed 152 kgs and is now down to 110 kgs. “My target is to bring my weight down further to 90 kilos,” he says.

In the Gastric Banding procedure, an adjustable silicon band is placed on the upper third of the stomach, making the stomach into one small portion and one large portion. The smaller portion, which is about 30 ml in volume capacity, is now the new stomach. The procedure takes one hour and is reversible.

This new stomach, owing to its reduced size, makes you feel full even when you have eaten small quantities of food. Shannon says he underwent the procedure last September. “I have to blend my solid foods well to make it easier for me to digest them,” he says. Before the surgery, he could barely manage to walk 22 metres before feeling winded. But now, “I can walk 3 kms,” he says. “I am committed to my diet programme.” Obesity runs in his family and his brother too had the same procedure done to lose weight.

***

 

 

Gastric sleeve

American expatriate Allicia McCorkle was fed up of dieting, losing weight and then gaining it back all over again.

Her weight kept going up and down for the past 7 years until she recently underwent the gastric sleeve procedure. “I am not denying myself anything now,” she says about her diet which she eats in smaller servings. “The gastric sleeve reduces the stomach to the size of a banana,” she says. Now she makes every meal count. She says that earlier when she dieted, there were many restrictions as to what she could eat.

Allicia underwent the sleeve gastrectomy procedure where a portion of the stomach is removed. The portion removed includes the part where it secretes the ghrelin hormone that increases the desire for food and makes high-calorie foods look more appealing.

Weight control, as a result of this, is faster through this procedure and is sustained.

Allicia has to make follow-up visits to the doctor who checks for vitamin deficiencies, if any, and is advises diet changes.

Speaking of her decision to undergo the surgery, Allicia says, “This was the last thing I wanted to do, but it is the best thing I did for myself. I needed someone to help me.”

 

Filipino expatriate Aaron Dann C. Gegajo, 30, not only lost weight after undergoing the gastric cleeve procedure, the same as Allicia. but his high cholesterol levels too dropped, his blood pressure has gone down, and his self-esteem is now high.

“Purchasing clothes is so easy now,” says Aaron, who dropped 25 kgs - from 105 to 80. Earlier, he was the only obese person in his family. “The urge to eat a lot is gone,” he says. Aaron now plays sports such as basketball and goes cycling.

 

***

Gastric balloon

Mohammad Seoudi, an Egyptian, was also desperate to lose weight and the maximum he ever lost through dieting was 5 kgs.

He did not want surgical intervention so he opted for a gastric balloon procedure. The silicon ballon is placed in the stomach through the mouth and then inflated inside by filling it with saline solution. The procedure takes 30 minutes in the hands of an expert surgeon. The patient stays in the hospital for about 6 hours for observation and can go back to his daily routine subsequently.

The balloon takes up a lot of space inside the stomach leaving very little space for food. So you feel like eating less. Seoudi says he felt a slight pain initially after the procedure but now he eats whatever he wishes, but within limits.

He earlier weighed 162.5 kgs and since the procedure last December, has lost 20 kgs. “I have changed my lifestyle too,” he says.

The balloon is removed after six months through the mouth using an endoscope. The weight loss during this time will be about 25 kgs.

Comments (2)

  1. Added 12:06 June 13, 2013

    Dear readers, this is a magnificant way to lose weight. I did this in India in Jan 2012. I was 130Kg and after a year I am 75Kg. It is like a rebirth. I used to have lot of illness like hypertension, cholestrol, border line blood sugar and uric acid. I used to take at least 6 to 7 pills a day. After 4 months of surgery, i stopped all the pills. Of course your eating becomes minimal, but that is worth it. Again I had a major wardrobe malfunction, again worth it. I urge all my freinds who are obese, live to eat do not eat to live. Go ahead for this surgery and you will have a new life.

    Clavin Fernandis, Abu Dhabi, United Arab Emirates

  2. Added 09:38 June 13, 2013

    It would be nice to hear from the insurance companies that these types of surgeries can be covered by medical insurance when comorbidities like diabetes exist in patients. For patients like these, it is not cosmetic surgery, it is a matter of life or death. The doctor says "diabetes is curable" with these surgeries. How can the cure for a deadly disease cost a patient with insurance Dh40-50,000? It would be nice to see HAAD and the Dubai Health Authority recognised this and insist that insurance companies cover these surgeries when recommended by a doctor.

    Donald Glass, Abu Dhabi, United Arab Emirates

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