Obesity today ranks as a significant health challenge and studies show obesity to be a major cause of preventable mortality. Obesity, perhaps in the next 25 years will become the biggest financial drain on one’s family and country along with other associated life style disorders like Diabetes and Hypertension to name a few. Obesity refers to a spectrum of problems of excess weight ranging from being mildly overweight to being morbidly obese. Patients with morbid obesity do not tend to respond to medical means of weight loss.
What is Obesity?
Obesity is a condition in which the natural energy reserve, stored in the fatty tissue of humans and other mammals, is increased to a point where it is associated with certain health conditions or increased mortality.
What Causes Obesity?
The etiology of obesity is multifactorial. Over eating is the primary cause, but – psychological problems, hormonal imbalance, eating disorders, lack of proper directions in diet could all play a part. Likewise, the treatment options for obesity are varied – including diet and exercise, body contouring surgery, bariatric surgery, psychological counseling, endocrine management, etc. The most common causes for obesity include
Lack of activity
Overeating/ Unhealthy eating habits
Hormonal problems like Cushing’s syndrome and PCOS
Genetic reasons/ Familial obesity
What is Obesity Surgery?
Obesity surgery includes a variety of procedures performed on people who are obese. Weight loss is achieved by reducing the size of the stomach with an implanted medical device (gastric banding) or through removal of a portion of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch) or by resecting and re-routing the small intestines to a small stomach pouch (gastric bypass surgery). Long-term studies show the procedures cause significant long-term loss of weight, recovery from diabetes, improvement in cardiovascular risk factors, and a reduction in mortality of 23% from 40%.
Types of Obesity Surgery
There are several types of obesity surgery which fall into one of the following three categories:
Restrictive: This is the term given to a set of procedures which cause a physical reduction of the stomach volume. At present there are three procedures although one of them – Vertical Banded Gastroplasty is no longer recommended due to a high rate of side effects. Food intake is reduced as result of smaller stomach capacity: and less food means a reduced calorie intake which will result in weight being lost.
These include the following procedures:
Sleeve gastrectomy (single technique)
Malabsorptive: A malabsorptive procedure is one in which the absorption of food is greatly affected. When food is ingested it passes down the gullet (windpipe) into your stomach. It is then broken down by stomach acids. As it leaves the stomach and enters the top part of the small intestine or duodenum, it comes into contact with digestive juices from the pancreas and bile from the gall bladder. These two cause a further breakdown of the food which means that vital nutrients such as vitamins and minerals are absorbed. However, with a malabsorptive procedure this ability is vastly reduced. Food is not properly absorbed which means that important nutrients are lost. This can result in vitamin/mineral deficiencies. You will be given daily supplements to replace these. Malabsorptive procedures, such as the jejuno-ileal bypass are no longer performed.
Combination (restrictive/malabsorptive): These are ‘double whammy’ procedures: by this we mean that they are comprised of both a restrictive and malabsorptive element. The restrictive element is the physical reduction of the stomach: which means that smaller meals will have to be eaten (reduced food intake). Combination procedures or ‘restrictive/malabsorptive’ procedures are the preferred option. The malabsorptive element refers to the rerouting of the small intestine (see gastric bypass for a more detailed description) which affects food absorption.
There are four procedures which fall into this category:
Roux-en-Y gastric bypass
Mini gastric bypass
Biliopancreatic diversion (with or without duodenal switch)
Sleeve gastrectomy with duodenal switch
These are all technically demanding procedures but when performed by an experienced surgeon can result in dramatic weight loss.
Preparing for the Surgery:
The best preparation is to understand the risks and potential benefits and to closely follow your doctor's instructions.
To mentally prepare yourself:
Understand the surgical process and what to expect afterwards.
Talk to people who have had weight loss surgery.
Write a letter to yourself and your surgeon explaining your reasons for having the surgery and outlining your plans to maintain your weight loss after surgery.
Start a journal about your experience. Record how you feel now, the obstacles you encounter, the things you hope to be able to do after surgery.
Get a letter of support from your family. It helps to know you have people behind you, waiting to help.
To physically prepare yourself, strictly follow your doctor's guidelines. These usually include, but are not limited to:
Restricting yourself to a clear liquid diet 12-24 hours before surgery.
Stop smoking for at least a month before surgery.
Be certain to follow your surgeon's instructions regarding any medications you may be taking to control other health conditions.
Arrive on time, with supplies from home for a three- to four-day hospital stay. If you use special equipment for sleep apnea, you should bring your machine to the hospital.
Common Obesity procedures
Gastric Bypass:Gastric bypass is a complicated surgery that can last up to four hours. The most common type of gastric bypass is Roux-en-Y-gastric bypass, which is performed with one long incision. Using staples or a plastic band, a surgeon makes a small pouch at the top of the stomach. This smaller stomach is connected to the section of the small intestine called the jejunum. With this rearrangement, food bypasses the rest of the stomach. The patient feels full more quickly, so fewer calories are consumed and absorbed by the body.
Gastric Banding: Made of inflatable silicone, gastric bands restrict the stomach. Using one of the two types of gastric bands available in the United States (the Lap-Band System or the Realize Band), a surgeon wraps a band around the top section of a patient's stomach by means of laparoscopic surgery. The band is injected with saline, causing the patient to feel full sooner and eat less. Gastric banding is a less invasive surgery and can often be performed on an outpatient basis. The bands can also be tightened or loosened as needed.
Duodenal Switch: The duodenal switch combines two surgical approaches. First, a surgeon removes about 85 percent of the stomach. What is left is shaped like a banana, about 6 ounces in size. Next, a large section of the small intestine, the section where most digestion occurs, is cut out and bypassed. With a smaller remaining section of the intestines involved in digestion, not as many nutrients and calories can be absorbed, so patients lose weight.
Gastric Sleeve Surgery: Gastric sleeve surgery is a newer type of weight-loss surgery. The laparoscopic procedure is typically used to kick-start weight loss for the extremely obese---people who are too overweight to withstand more invasive surgeries. During a gastric sleeve operation, a surgeon removes more than half of the patient's stomach. What's left takes a sleeve- or tube-like shape, and it is sealed with staples. When the patient has lost enough weight, he or she may then undergo gastric bypass or another type of weight-loss surgery.
Gastroplasty: It is also known as "stomach stapling," was once a popular type of weight-loss surgery. The original gastroplasty debuted in the 1970s. It involved stapling the stomach into a smaller section, so only a small opening was left for food. Surgeons eventually began performing Vertical Banded Gastroplasty (VBG). In this type of surgery, both staples and a band are used to reshape the patient's stomach into a small pouch. Like regular gastroplasty, only a small hole is left for food to travel into the rest of the stomach. Today, gastroplasty is not performed as often, as studies indicate many patients regain weight.
Sleeve Gastrectomy: This procedure reduces the stomach by 15% of its original size, by surgical removal of a large portion of the stomach, following the major curve. The open edges are then attached together (often with surgical staples) to form a sleeve or tube with a banana shape. The procedure permanently reduces the size of the stomach. The procedure is performed laparoscopically and is not reversible. It is usually performed on extremely obese patients, with a body mass index of 40 or more, where the risk of performing a gastric bypass or duodenal switch procedure may be too large.
Roux-en-Y Gastric Bypass: is currently the most commonly performed bariatric operation with roughly 7 out of 10 bariatric surgeons use it as their primary weight loss procedure. An easier gastric bypass operation than either Biliopancreatic Diversion Stomach Bypass, or Duodenal Switch Stomach Bypass, Roux-en-Y has been practiced for more than 30 years, during which it has demonstrated a high long-term success rate with relatively low rates of mortality (less than one percent) and post-operative health complications. Roux-en-Y patients typically lose 50-75 percent of their initial excess weight, which is a sufficient weight reduction to cure or significantly reduce most of the life threatening medical conditions associated with severe clinical obesity.
Gastric Balloon: is becoming a popular alternative to ‘going under the knife’. It is a non-invasive procedure which means no general anaesthetic or overnight stay and can be done quickly and painlessly. It can take as little as 10 minutes and you can return home after an hour. You are looking at just a day spent at home recovering although you will experience some nausea in the first week following this procedure. Your suitability for this procedure will be discussed with your surgeon. This is exactly the same as for any other obesity procedure. He/she may recommend this if you do not want surgery; if you do not fulfill the criteria for obesity surgery or as a means of achieving weight loss before undergoing a surgical procedure.
Advance Obesity Surgeries
ROSE Procedure: ROSE, stands for Restorative Obesity Surgery, Endolumenal, is a new, safer, incision less, gastric bypass revision. It is not a primary method of weight loss surgery, but a follow-up procedure that is specifically designed for gastric bypass patients with weight regain. The ROSE procedure is indicated for gastric bypass patients who were initially successful in losing the excess weight but are now regaining some of the lost weight because the stomach and stoma have stretched out and no longer effectively control hunger and food intake.
Life after Obesity Surgery
Obesity surgery is not a quick fix. It's an ongoing journey toward weight loss through lifestyle changes. After surgery, the difference in your body makes it physically easier to adjust your eating and lifestyle habits. Fortunately, you will not have to go through the process alone. A team of professionals will be there to support your efforts. Positive changes in your body, your weight, and your health will occur, but you will need to be patient through the recovery process. The following are some of the generally accepted dietary guidelines for a healthy diet after bariatric surgery:
When you start eating solid food, it is important to chew your food thoroughly and eat very slowly. It is important to wait two to three minutes after swallowing before putting the next bite of food in your mouth.
Don't drink fluids while eating. They will make you feel full before you have eaten enough food. Fluids consumed with meals can cause vomiting and dumping syndrome, and can lead to feeling hungry sooner after a meal.
Don't eat desserts and other items with sugar if they have more than 3 to 5 grams per serving size.
Avoid carbonated drinks, high-calorie nutritional supplements, milk shakes, foods high in fat, and foods that have no nutritional value.
Limit snacking between meals. Eating after bariatric surgery will be much different than before!
Benefits of Obesity Surgery
Obesity surgeries and procedures are designed to reduce illness and complications caused by obesity. For many, weight loss improves multiple conditions including high blood cholesterol, high blood pressure, diabetes, and coronary artery disease. In addition, other body systems, including digestive, endocrine, and immune system benefit. However, such procedures require dedication and determination for those who undergo them to maintain permanent lifestyle changes. After surgery, patients who follow instructions may enjoy as much as a 60% weight loss, improving health problems as an added benefit.
Risks of Obesity Surgery
All surgeries come with the possibility of complications, but fortunately their incidence is quite small. These include, Slippage of the band due to food intolerances or even perforation of the stomach, vomiting after the surgery may develop which can lead to a small stomach pouch stretch. While in 10-20% of the cases, abdominal hernia may occur. It can be caused by vomiting or straining after surgery, usually before the incision heals.
Obesity Surgery in India
India has become a Mecca for various obesity surgeries for the international patients coming all across the world. The world has realized the fact that the healthcare technologies in India are at par with that provided by the healthcare facilities in any advanced country, using exactly the same advanced technologies, machines and equipments as used in USA or Europe thereby delivering similar or even better results. Adherence to the highest quality standards of healthcare by competent weight loss surgery specialists with priority treatment.
Most of the obesity surgeons and doctors in India performing minimally invasive Lap Gastric Banding, vertical sleeve Gastrectomy and Roux-en-Y Gastric bypass have graduated from top medical school universities of North America-USA, Canada, UK, Europe, Australia and have vast overseas healthcare surgery experience and training from best hospitals. The foreign patients can therefore avail the finest board certified medical professionals- board certified surgeons, board certified doctors, physician and JCI – JCAHO accredited, government registered and approved private medical Healthcare facilities in India for their respective surgery.
Thus a world-class low price facilitation services for the visiting overseas patients for their cheaper surgery treatment trip at the top rated private specialty hospital and clinical facilities in the following Indian cities:
Besides, having a world class medical treatment, the foreign patients also have the opportunity to explore the country’s heritage places like the Taj and Red Fort, along with the natural scenic places of Goa and Kerala encompassing all the beauty which Mother Nature’s empowers these areas.
Cost of Obesity Surgery in India
The greatest benefit the foreign medical tourist can avail in India is the cost factor. They get personalized attention at incredible costs which are the root cause of driving the patients worldwide to India for different procedures of obesity surgery. One can assess the significant differences at cost purse from the following table:
Laparoscopic Adjustable Gastric Banding AGB
Laparoscopic Gastric Bypass Roux-en-Y RGB
Laparoscopic Vertical Sleeve Gastrectomy VSG
Some of the common countries from which patients travel to India for surgery are: