Abu Dhabi: Among the increasing numbers of the obese in the UAE, many are opting for bariatric surgery to shed excess body fat. But that’s not the only story here.
A critical element in ensuring a satisfactory outcome for this surgery is a thorough psychological assessment, states a research conducted by the UAE University in Abu Dhabi.
A team of researchers decided to study the psychological characteristics that may potentially complicate the surgical management of obesity, the study said, as the issue has immense value in ensuring that patient’s weight management post-surgery is optimised.
These conditions may often complicate the surgical management of obesity, the study found.
For the purposes of the study, a total of 105 patients attending a bariatric clinic in Al Ain’s Tawam Hospital were surveyed — 70 per cent of them were women.
Nearly 40 per cent of these participants said they felt that their obesity interfered with their performance of religious duties, and about 35 per cent said it affected their ability to engage with family and friends or complete household tasks.
Anxiety, depression
At the same time, 24 per cent of participants exhibited symptoms of anxiety, while 13 per cent showed depressive symptoms, which negatively affected their quality of life.
“The recognition, assessment, and treatment of these symptoms would be conducive to ensuring positive outcomes for bariatric surgery,” Dr Osman advised.
In the UAE, it is mandated that patients undergo psychological assessment and lifestyle modifications for up to six months prior to bariatric surgery.
“We have to opt for different kinds of surgery based on the patient’s eating behaviour, and these can only be determined through psychological evaluations,” said Dr Toufic Ata (right), consultant for general surgery at Medeor 24x7 Hospital in Abu Dhabi
For example, a patient who eats large quantities of food can benefit from a sleeve gastrectomy, which reduces the stomach’s ability to take in and store food, the surgeon explained.
“On the other hand, a reduction in mere stomach capacity would not benefit those who binge in spurts throughout the day or eat small calorie-laden foods regularly, so we would advise gastric bypass surgery for them,” he said.
MORE ON BARIATRIC SURGERY:
• Bariatric surgery: what is available in UAE
• Bariatric surgeries may become more accessible in UAE
CASE STUDIES
‘Benefits outweigh any risks’
20-year-old Emirati has lost 39 kilograms after weight-loss surgery
“I had tried everything I could think of. Physical activity was difficult because of the weight I had put on. But under the advice of a nutritionist, I tried a number of diets,” Mubarak, a 20-year-old Emirati university student, told Gulf News.
“For example, I tried to blood type diet, which recommends foods that are healthy for you based on your blood type. I also tried another regimen in which I was eating fewer meals than usual. In addition, I tried appetite-suppressing injections. But nothing worked,” she said.
At a subsequent physical assessment, doctors told Mubarak that she was beginning to develop some degree of heart failure.
“When I heard this, I knew I needed to do something. That’s when I approached a surgeon for other options, and bariatric surgery was recommended to me,” Mubarak said.
‘How ready am I’
Mubarak underwent a psychological assessment to determine her readiness for the procedure, and started a protein-based diet.
Then, on January 17, she underwent weight-loss surgery, and its costs were covered under the Thiqa health insurance scheme for Emiratis. Within a month, she lost 10 kilograms.
“I was on a liquid diet for the first couple of weeks after the procedure, and the weight loss was quick. As time went on, I had to adjust to smaller portion sizes, and had to give up soft drinks entirely,” Mubarak recounts.
After surgery
For her, the hardest part was ensuring that she took her vitamins daily.
“I wasn’t used to it, and that made it hard. But on hindsight, I wish I had got the surgery earlier. After the procedure, I could climb stairs easily, and while I had sometimes had to use a wheelchair earlier, I could walk great distances with ease,” Mubarak said.
She has lost 39 kilograms since the surgery, and says she would not have it any other way.
“The risks were explained to me, but I wasn’t hesitant. In fact, I can vouch for the fact that the benefits greatly outweigh the risks,” she added.
“People said I was fat and lazy, and it was true’
44-year-old expat saw his sleep apnoea and hypertension cured after the surgery
Standing at 5 feet 11 inches, Lynock’s height hid some of his weight. But the comorbidities of obesity were unmistakable.
“I was suffering from sleep apnoea, diabetes, hypertension and hypocholesteraemia. And I knew it was not healthy to have gained 30kg,” Lynock told Gulf News. “The worst part was that I was always tired. I had no energy to take my children to the park, even on weekends, and when people said I was fat and lazy, I knew it was true,” he added.
Lynock remembers being impatient to undergo bariatric surgery, but his surgeon ensured that he saw a psychologist. Because of his sleep apnoea, sleep training was also part of the prep for the surgery.
“I saw different specialists who worked with me to prepare for the changes after the procedure. All of this took about three months. At the same time, in the month before the surgery, I was on a protein-heavy diet that included milkshakes, soups and protein bars,” Lynock said.
Back at work
Lynock finally underwent bariatric surgery at Healthpoint in October 2016, and it cost him Dh45,000.
A day after the procedure, his blood pressure returned to normal levels and within three days, his sleep apnoea was cured. In time, his diabetes also became a worry of the past. “I was back at work in five days, and within a year, I had lost all the 30 kilograms of excess weight,” Lynock said.
More importantly, he was able to do many things that had not been possible before.
“I had wanted to get on the roller coaster at Ferrari World, and I could finally do it. I now go swimming two to three times a week, and regularly play tennis with my wife. And instead of being the one who gets tired at the park, it is my toddler who tires out first. It’s a great feeling,” Lynock said.
The procedure did, however, mean that the father of three had to consciously make some lifestyle changes. Initially, Lynock was unable to eat solids for three months, and afterwards, he has to reduce his portion sizes.
“It also required a change in mindset. I would sometimes use food to comfort myself, and I had a few down days after the procedure because I could no longer do that. But I soon trained myself to eat a kid’s meal instead of a Big Mac with fries,” Lynock said.
“I could not even sit comfortably”
Father-of-six beats diabetes with bariatric surgery
“I was unable to play with my children, and hours in an exercise bike had yielded no results,” Al Musabi told Gulf News.
Increasingly blurred vision proved to be the last straw for Al Musabi, and he finally sought help.
“My lifestyle was hard to change, especially given my working hours, but the physical difficulties I was facing became unbearable. In fact, I could not even sit for long without facing excruciating pain in my back, and walking was always a chore,” Al Musabi said.
The father of six underwent bariatric surgery in September 2016, with the support of his wife and family. Weighing 105 kilograms before the procedure, he has lost 36 kilograms since then, and said he feels well again.
He now weighs a healthy 69 kilograms.
Enjoying normal life
“There are misconceptions about bariatric surgery that suggest you cannot enjoy a normal life after it. In fact, I now have to see far fewer doctors now, and I do not suffer from diabetes any longer. It took just one month after the surgery to resolve this otherwise-lifelong disease,” Al Musabi said.
While some patients feel uncomfortable in the run-up to a weight-loss procedure, Al Musabi was reassured by his surgeon, as well as psychologist who assessed his mental state before the procedure.
“I would recommend bariatric surgery to all overweight patients, but of course only a specialist can determine if you fit the criteria for the procedure. From my viewpoint, it has changed my life. I was unable to do something as simple as sitting cross-legged before the surgery; now I don’t have to give it a second thought,” he said.
The procedure has also brought about other subtle but satisfying changes to his life. Al Musabi is able to find clothes that fit him more easily. And while he used to be able to eat three shawarmas one after another in the past, he can now stomach only one at a time.
“I think I still eat the same food, but the portion sizes are much smaller and more balanced,” he said.
“For me, bariatric surgery was a tool to turn my life around”
Mother-of-two did lost 57 kilograms after procedure, and reduced her risks of developing diabetes and cancer, which run in her family
“At my heaviest, I weighed 103 kilograms. My knees couldn’t handle the weight, and I was terrified when a scan revealed pre-cancerous cells in my ovaries. I didn’t want to become diabetic, and I knew I had to do something,” Al Azri, a homemaker, told Gulf News.
The mother of two was even beginning to get depressed, not liking her reflection in the mirror.
“I began to consider surgery as a tool to turn my life around, and although my husband was initially opposed to the idea, he saw how important effective weight loss became to my well-being,” Al Azri recounts.
Once she decided that bariatric surgery was an option, Al Azri had to undergo a series of psychological consults …. while sticking to dietary requirements. In May 2016, Al Azri underwent a gastric bypass at Healthpoint.
Liquid diet
“I was dazed when I regained consciousness after the surgery, and there was definitely some pain and discomfort. I also had to adhere to a liquid diet for a few weeks, and I was exhausted during the first few weeks because I was eating so little. All in all, though, the discomfort eventually passed,” she said.
Most encouragingly, the weight loss was quite rapid and within a year and a half, Al Azri had lost 57 kilograms.
“What I learnt was that the surgery was a tool. It was not responsible for the weight loss entirely, and I myself had to make lasting changes,” she said.
For instance, Al Azri now ensures that she does not opt for fast food for more than one meal a week, and she has replaced her carbohydrate-heavy meals with portions of vegetables and fruits. She also avoids indulging in desserts, and spends an hour at the gym four days a week.
“I am definitely far less tired now, given that I can fit in a gym session after finishing all my household chores. And I am more comfortable with myself,” Al Azri said.
She added that she had heard of adverse outcomes after bariatric surgery, and her own mother-in-law had had to remain in intensive care after a weight-loss procedure.
“But my family has a history of diabetes and cancer. Knowing obesity is a contributor to these risks, I am glad I was able to use surgery to get my life back on track,” Al Azri said.
