Experts say bariatric surgeries can result in long-term weight loss and significantly improve physical and emotional health and even longevity
If you’re investigating the benefits of a bariatric procedure, you’ve probably tried every fad diet known to humankind to shift your excess weight. While strict eating and physical activity regimes may have positive results for some people, all bodies have varied responses to extreme diets and activity. If you’re one of the 27.8 per cent of adults and 17.35 per cent of children and adolescents in the UAE classified as obese, there could be multiple factors that are contributing to your condition — many of which are beyond your control.
Here’s why bariatric surgery, also known as weight loss or metabolic surgery, remains a successful option that experts say is quickly becoming the most popular weight loss solution. The approach is now simpler, safer and more effective than in its early days in the 1990s.
Bariatric surgery is an operation that is performed to help obese individuals lose weight. Evidence suggests that bariatric surgery may lower death rates for patients with severe obesity, especially when coupled with healthy eating and lifestyle changes after surgery. “The surgical procedure aims to help people with obesity lose weight by altering the digestive system’s anatomy or limiting the amount of food the stomach can hold,” explains Dr Hussam Al Trabulsi, General and Bariatric Surgeon at Medcare Hospital Al Safa. “It’s usually recommended for people with a body mass index (BMI) of 40 or above or those with a BMI of 35 or above who have obesity-related health problems, such as type 2 diabetes, high blood pressure, or sleep apnea.”
While being the art and science of managing obesity and its medical complications, Dr Raad Almehdi, Consultant surgeon and head of department of bariatric and metabolic surgery, Burjeel Medical City, says it is a more definitive and longer lasting way than conventional non-invasive methods. “While all medical means to tackle obesity consolidate each other, surgery remains, through international scientific consensus, the most enduring approach for achieving a healthy body weight and hence the desired metabolic balance,” says Dr Almehdi.
The global awareness of the disease has geared the recommendations for surgery to evolve and to follow a frame and pathway that relates to different parameters, including the patient’s weight, fitness, presence of medical metabolic complications (such as diabetes), and a long-term follow-up plan to ensure good outcomes. “Presently in the UAE, surgery was advised for patients with BMI above 35 with metabolic or other health problems as well as to those with BMI 40 and above regardless of health issues, but now the latter indications have been revised in international guidelines to include patients with BMI above 32 with medical issues within the same frame,” says Dr Almehdi.
There are various types of bariatric surgeries that can be performed. Surgery may be performed using an “open” approach, which involves cutting open the abdomen or by means of laparoscopy, during which surgical instruments are guided into the abdomen through small half-inch incisions. Today, most bariatric surgery is laparoscopic because compared with open surgery, it requires less extensive cuts, causes relatively minimal tissue damage, leads to fewer post-operative complications and allows for earlier hospital discharge.
Surgery for obesity and metabolic diseases has evolved exponentially in the UAE over the past decade. With obesity affecting the Gulf region in significant levels, the expansion of quality surgery in the country has taken the forefront. “Almost all procedures are done now in select highly established hospitals,” says Dr Almehdi. “This includes operations for both primary and revision cases. The spectrum vary from operations that restrict intake (e.g sleeve gastrectomy) to those that reduce absorption and/or help reset the internal gut balances (gastric bypass in its many varieties). Similarly, revision operations to amend weight regain or the occasional primary surgery complications have gained a strong foothold with the expansion of the field and the availability of the expertise to tackle such problems.”
Besides these, hospitals in the UAE, also offer other bariatric surgeries such as gastric band surgery and biliopancreatic diversion with duodenal switch. “The gastric band surgery involves placing a band around the upper part of the stomach, creating a small stomach pouch above the band. This limits the amount of food you can eat and makes you feel full faster,” says Dr Al Trabulsi. “The biliopancreatic diversion with duodenal switch involves removing a large portion of the stomach and rerouting the small intestine to the remaining stomach, which limits the amount of food you can eat and reduces the number of calories and nutrients your body absorbs.”
All surgeries present their own share of risks and they vary with each patient. However, in the appropriate patients, experts say the health risks from obesity far outweigh the risks associated with bariatric surgery. Metabolic and bariatric surgery is associated with major reductions in risk of premature death over a five-year period versus not having surgery. “It is very safe and equally safe as any other laparoscopic surgery such as that of the gall bladder. Its benefits are far greater than its risks, especially if you are morbidly obese and have developed associated diseases,” says Dr Girish Juneja, Surgeon of Excellence (IFSO Certified) for Bariatric and Metabolic Surgery. “You just need to be in the hands of an experienced surgeon and adhere to a good follow up plan.”
The field of bariatric metabolic surgery is dynamic and continues to advance based on the emergence of new procedures with improved risk/benefit profiles. Today’s metabolic and bariatric operations have been refined over the course of many decades and are among the best studied treatments in modern medicine. They are performed with small incisions using minimally invasive surgical techniques (laparoscopic and robotic surgery). These advancements allow patients to have a better overall experience with less pain, fewer complications, shorter hospital stays and a faster recovery. These operations are extremely safe, with complication rates that are lower than common operations such as gallbladder removal, hysterectomy, and hip replacement.
“With maturity of endoscopic techniques, there is a trend of moving from laparoscopic bariatric surgery to endoscopic procedures such as gastric balloon, which is very popular, endoscopic sleeve gastroplasty (ESG) and combination approach such as using weight-loss medications along with established bariatric procedures,” says Dr Juneja.