Obesity surgery: All your questions answered

Obesity is a global epidemic. Currently 250 million adults worldwide are classified as obese. If the current trend continues, 75 per cent of adults and 25 per cent of children will be tipping the obesity scales by the year 2050. Now is the time to take action. Samantha Dobson finds out more about the most drastic measure of all - surgery.

One out of every four individuals in Westernised societies is suffering from the harsh effects of being overweight - a condition that is often linked to other serious medical conditions such as heart disease, high blood pressure and diabetes (90 per cent of severely obese people are diabetic).

Being obese can literally knock years off your life. A body mass index (BMI) higher than 30 (which is the measure of obesity) decreases a person's life expectancy by up to 13 years, making it more of a health hazard than smoking.

For the very obese, standard weight loss methods such as diet, exercise and even medication is often ineffective as excessive weight is often regained.

Once seen as a last resort, patients in this category are increasingly turning to gastric bypass surgery as a solution. Specialist bariatric surgeon, Dr Ramesh Kumar from the NMC Specialty Hospital Dubai, fills in the details.

Q When are you simply overweight and when are you clinically obese?

"The main measure of obesity is known as the body mass index, or BMI," explains Dr Ramesh.

"Your BMI is calculated by taking your weight in kilograms and dividing it by the square of your height in metres. So, if you are 1.6 metres tall and weigh 65 kilograms your BMI would be 25.4 [65 / (1.6 x 1.6)].

"A BMI of between 18.5 and 24.9 is considered normal while a BMI of between 25.0 and 29.9 would indicate that you are overweight. Once you reach a BMI of 30 you are classed as obese.

"Obesity is often confused with being overweight, but in clinical terms, the difference is important since obesity is considered to be a serious medical condition.

"If your BMI reaches or exceeds 38 you are morbidly obese. At this point you start to run the risk of developing a number of life-threatening health problems such as type-2 diabetes, coronary disease and stroke.

"My most recent patient had a BMI over 68 and weighed in excess of 200kg. This region is known to have one of the highest incidents of obesity-related type-2 diabetes in the world."

Q What are the factors contributing to the alarming increase in morbid obesity?

"The reasons are many and varied," says Dr Ramesh.

"It's likely a combination of genetics, the fact that many people are now far less active than they used to be, and over-consumption of low-cost, highly-processed convenience foods.

"It's a simple and often pleasurable experience to consume far more calories than we are burning off. The result is the global epidemic in obesity we are now experiencing."

Q What alternative treatments are offered for obesity before surgery?

"Diet and exercise programmes can produce an average weight loss of eight per cent of total body mass, which, while it may not sound a lot, can result in significant health benefits," says Dr Ramesh.

"Much more difficult is keeping that body fat off. Unless exercise and conscious eating become a permanent part of a person's lifestyle, 80 to 95 per cent of obesity dieters will gain this weight again within two to five years.

"Where a patient with a BMI of more than 38 fails to respond to dieting and drug therapy and/or develops obesity-related complications such as diabetes, the only permanent solution is surgery."

Q What is the difference between gastric banding and a gastric bypass?

"Gastric banding involves attaching an adjustable silicone band around the upper part of the stomach to limit food intake," saysDr Ramesh.

"But I personally don't recommend it. The procedure is still relatively new and the results to date are not encouraging. Patients still gain the weight again after two to three years. In my opinion the only permanent, effective solution is a gastric bypass."

Q What is a gastric bypass and how is it effective?

"Gastric bypass surgery makes the stomach smaller and allows food to bypass part of the small intestine," explains Dr Ramesh.

"You will feel full more quickly which reduces the amount of food you eat and thus the calories consumed. Bypassing part of the intestine also results in fewer calories being absorbed. This leads to permanent weight loss. The most common is a Roux-en-Y gastric bypass."

Q Can you explain this procedure in more detail?

"In this procedure, surgical staples are inserted across a portion of the upper stomach to separate a small pouch," says Dr Ramesh.

"This is connected directly to the middle portion of the small intestine, bypassing the rest of the stomach and the upper portion of the small intestine. The small bowel is then attached to a tiny opening in the upper stomach, effectively bypassing the remainder of the stomach.

"A small incision is made using minute instruments and a camera to guide the surgery. The result is a 'Y' shaped stomach; Roux is the French surgeon who devised it, hence the name."

Q What is the dumping syndrome associated with gastric bypass?

"In a Roux-en-Y bypass the stomach's plumbing is essentially re-routed, forcing food to move quickly through the stomach and intestines.

"The dumping syndrome may occur if large amounts of highly refined, fatty or sugary foods are consumed. It causes discomfort including nausea, chills, sweating, faintness, cramping and possibly diarrhea soon after eating.

"In some cases you may become so weak that you have to lie down until the symptoms pass. It's not dangerous, but is more a physical reminder to discourage overeating and to avoid the types of food that made the patient obese in the first place."

Q How long will surgery and recovery take?

"The procedure is laparoscopic, or key-hole, which greatly reduces recovery time. The patient may be up and walking the same day.

"A hospital stay is necessary for observation over a three to four-day period. A liquid-only diet follows for up to two weeks. Provided there are no complications, the patient can expect to return to normal activities within two to three weeks."

Q What are the potential risks of gastric bypass?

"Any type of surgery carries risks and these are higher for an obese or overweight person," says Dr Ramesh.

"The most common risks are: wound infections, blood clots in the legs or lungs, pneumonia, loss of spleen, stomach ulcer, stomach leakage, peritonitis and staple line failure. Any of these complications can and have been life-threatening, but precautions are taken and the patient is monitored.

"Mortality is rare with this type of surgery - statistically one in 400 patients will die. More common is nutritional deficiency conditions such as anemia or osteoporosis.

"In a gastric bypass, the part of the intestine where many minerals and vitamins are most easily absorbed is bypassed.

"Because of this, up to one-third of patients may develop nutritional deficiencies in iron, calcium, magnesium, or vitamins. A sensible diet and taking supplements can prevent this.

"It is important after surgery to eat wisely (meaning limited sodas, junk food or fried foods) and to exercise regularly," he cautions.

"This operation is not an easy way out. In fact, it is a serious and drastic last resort to weight control. It should be approached with the same caution and seriousness that any major operation demands."

Q Who should consider this surgery?

"Surgery is generally considered if you are between 18 and 65 years of age with a BMI of 38 or higher, or you have a life-threatening or disabling condition related to your weight," says Dr Ramesh.

"Those eligible for surgery must have had previous unsuccessful attempts at weight loss and demonstrate a willingness to make the necessary changes in lifestyle and eating habits.

"Surgery would be considered for patients for whom weight loss is imperative - such as those suffering from diabetes, high blood pressure, heart trouble, shortness of breath, arthritis, and orthopedic (bone) problems.

"Because of the bypass's effect on the digestive system sugar is not absorbed so high blood sugar and type-2 diabetes are cured completely."

Q How well does a gastric bypass work?

According to Dr. Ramesh most people who have gastric bypass surgery quickly begin to lose weight and continue to lose weight for up to 12 months after surgery. One study noted that people lost up to two-thirds of their excess weight in one to four years.

Q Who can perform gastric bypass and how much will it cost?

There are a number of practitioners in Dubai.

• Dr Ramesh is American-trained in Bariatric and Gastric surgery and works from the NMC Specialty Hospital in Dubai (04-2679999 or www.nmcgroup.net). In the past three months he has performed eight Roux-en-Y bypass surgeries. Prior to that, in America, he performed over 400. The total cost is estimated at Dhs30,000 for open surgery or Dhs45,000 for laparoscopic.
  
• Specialist surgeon Dr Gabi Wazz from the Dubai Cosmetic Surgery Centre, is also American-trained and performs obesity surgery at the Suleiman Al Habib Centre in Dubai's Healthcare City. Total cost including follow-up is Dhs55,000. For more information contact Dubai Cosmetic Surgery Centre, 04-4297777 or www.dubaisurgery.org.)
  
• American Hospital Dubai has an obesity clinic with specialist laparoscopic and obesity surgeon Dr Paul Sayad. Call 04-3096553 or make an online appointment www.ahdubai.com. Cost is available following a consultation.