Exercise and diet alone often fail to effectively treat people with extreme and excessive obesity. Bariatric surgery is an operation that is performed to help such 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 basic principle of bariatric surgery is to restrict food intake and decrease the absorption of food in the stomach and intestines.The digestion process begins in the mouth where food is chewed and mixed with saliva and other enzyme-containing secretions. The food then reaches the stomach where it is mixed with digestive juices and broken down so that nutrients and calories can be absorbed. Digestion then becomes faster as food moves into the duodenum (first part of the small intestine) where it is mixed with bile and pancreatic juice.
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.
The preoperative evaluation is similar for all bariatric procedures. The components include determining a patient’s indications for surgery, identifying issues which may interfere with the success of the surgery, and assessing and treating co morbid diseases. Typical assessment includes psychological testing, nutrition evaluation, and medical assessment.
Patients referred for bariatric surgery are more likely than the overall population to have psychopathology such as somatization, social phobia, obsessive-compulsive disorder, substance abuse/dependency, binge-eating disorder, post-traumatic stress disorder, generalized anxiety disorder, and depression. Patients with psychiatric disorders may have a suboptimal outcome after bariatric surgery. It is not certain which psychosocial factors predict success following bariatric surgery, yet many programs exclude patients who are illicit drug abusers, have active uncontrolled schizophrenia or psychosis, severe mental retardation, heavy alcohol use, or lack of knowledge about the surgery.
We offer nutrition consultations for people undergoing gastric surgery and post-op consultations. Consultations include one-on-one counselling with a registered dietician. The nutrition consultant is an integral part of multidisciplinary bariatric care. He/she is charged with nutritional assessment, diet education regarding postoperative eating behaviours, and preoperative weight loss efforts.
Medical assessment prior to bariatric surgery is similar to abdominal operations of the same magnitude. Thorough history and physical examination with systematic review is used to identify issues that may complicate the surgery. Routine laboratory evaluation typically includes complete blood count, metabolic profile, coagulation profile, lipid profile, thyroid function tests, and ferritin. Vitamin B12, and fat-soluble vitamin levels may be evaluated if considering a malabsorptive procedure. Cardiovascular evaluation includes electrocardiogram and possible stress test to identify occult coronary artery disease. Respiratory evaluation may include chest X-ray and pulmonary function tests. Sleep apnea may be diagnosed by a sleep study if any was suspected. Upper endoscopy may be used if suspicion of gastric pathology exists. If H. pylori infection is present, preoperative therapy is advised. The liver may be assessed by hepatic profile and ultrasound. Ultrasound may be used to detect gallstones as well, allowing the surgeon to decide on concomitant cholecystectomy.
If you want to compare your weight status to others, BMI is a great method of analysis.
BMI | Term | Class of Obesity |
---|---|---|
<19 | Underweight | |
19-25 | Ideal BMI | |
25-30 | Overweight | |
>30 | Obese | I |
>35 | Severely Obese | II |
>40 | Morbidly Obese | III |
>50 | Super Obese | IV |
To be a candidate for obesity surgery, you must have the following criteria