According to the World Health Organisation, worldwide obesity nearly tripled between 1975 and 2016, and these days it seems as though the epidemic is continually escalating. With more than 1 billion people worldwide – including adolescents and children – currently classified as obese, at least 167 million are expected to face declining health by the year 2025. It affects populations across income brackets and age groups, posing considerable challenges to global health systems.
An issue like this can’t be solved overnight, but for anyone who is currently battling obesity, it may come as a relief to know there are effective treatment options available. Bariatric surgery is one way to address the physical, psychological, and social aspects of obesity. By improving your health outcomes, it can help you to save on the costs of future medical bills and enhance your overall quality of life – which, in turn, reduces strain on our healthcare systems.
If you or a loved one is affected by obesity, you might be wondering if bariatric surgery is the right path for you. The only way to know for sure is to book a consultation with a specialist, but here are some facts to consider before making your first appointment:
How Did Bariatric Surgery Come to Be?
Bariatric surgery has a rich history shaped by many pioneers in the medical field. Although we’ve long been aware of obesity-related health risks, the skills to implement effective surgery were only perfected in the last century. It’s generally agreed that the first successful surgery was the jejunoileal bypass in the 1950s, but unfortunately, the complications were too extreme. Many patients became unable to absorb vital nutrients and ultimately required reversal. However, the lessons learned from those early mistakes were invaluable for progress.
In the 1960s, a procedure now commonly known as gastric bypass surgery was performed for the first time. Known as the “Father of Bariatric Surgery” for his contribution to the practice, Dr. Edward Mason played one of the most crucial roles in developing the Roux-en-Y gastric bypass – a far safer method than previous attempts. Recovery time was minimal, weight loss was maintained long term, and complications were far less likely.
Since then, a multitude of dedicated surgeons, researchers, and medical professionals have continued to perfect the method, helping to expand our understanding of obesity and improve patient outcomes. Incorporating the laparoscopic technique has also made procedures less invasive, leading to less pain and less time spent in recovery.
Who Is Eligible for Bariatric Surgery?
Although carrying extra weight can be an uncomfortable and emotionally taxing experience for many people, being overweight will not always make someone eligible for these procedures. Bariatric surgery is intended for individuals who are severely overweight or have obesity-related health conditions, and as such, your doctor will have certain criteria that their patients need to meet before they will consider surgical intervention.
Body mass index (or BMI) is one of the top considerations. This is calculated using an individual’s height and weight to estimate their body fat levels. Those with a BMI of 40 or above are considered ‘morbidly obese’, and for these people, bariatric surgery is often a last resort with far higher chances of success than any other option. However, a BMI of 35 or more coupled with serious comorbidities like type 2 diabetes, hypertension, sleep apnea, or joint problems may also increase the chances of eligibility.
Other factors your doctor will take into account include age, overall health, medical history, and previous attempts at weight loss. Psychological and behavioural assessments are also important, as patients will need to demonstrate a commitment to lifestyle changes if they are to maintain their results long term.
What Are the Different Types of Bariatric Surgery?
Bariatric surgery encompasses a range of procedures, each with its own unique approach for different body types and health conditions. Though the various techniques may seem complicated, your surgeon will provide all the guidance you need to make the right choice for you. Two of the most common options are:
- Sleeve Gastrectomy (Gastric Sleeve)
Modifying the stomach from a sac-like structure into a slender tube, the ‘gastric sleeve’ surgery reduces its volume from roughly 2L right down to 100-150ml. By removing a portion of the stomach, the hunger hormone is reduced, helping to curb the appetite and limit the amount of food someone can eat before feeling full. It’s a popular procedure due to its effectiveness, resulting in about 60% excess weight loss, although individual results may vary. Surgical risks, including bleeding and leakage are minimal.
- Gastric Bypass (Roux-en-Y Gastric Bypass)
Instead of fashioning the stomach into a thinner sleeve, a Roux-en-Y Gastric Bypass is achieved by creating a small pouch out of the stomach, and then reconnecting this pouch further down the small intestine. This is fully reversible if necessary. The most common downside is nutrient malabsorption, which can be treated with supplementation. However, with an average weight loss of up to one third of total body weight, and high rates of maintained weight loss over the following 10 years, Roux-en-Y bypass is considered the gold standard of bariatric surgery.
What Are the Benefits of Bariatric Surgery?
No matter how it comes about, significant weight loss will always enhance the physical health of anyone who struggles with severe obesity. Often amounting to 50-80% of excess weight, the loss induced by bariatric surgery can also have the following benefits:
- Reduction of Comorbidities
Many obesity-related health conditions such as type 2 diabetes, hypertension, sleep apnea, gastroesophageal reflux disease (GERD), and dyslipidemia can be improved or resolved via bariatric surgery. This tends to significantly decrease the risk of cardiovascular disease as well.
- Higher Quality of Life
When mobility, physical fitness, and psychological health are improved, patients often report more self-esteem, healthier body image, and better social and economic opportunities due to their higher confidence.
Despite the upfront costs, bariatric surgery helps to save patients money in the long run by reducing the ongoing healthcare costs of obesity-related conditions.
- Enhanced Fertility
Being morbidly obese can negatively impact the fertility of both men and women. After bariatric surgery, men are likely to have higher sperm counts, while women are more likely to experience healthier pregnancy outcomes.
- Prolonged Lifespan
Several studies have shown that the successful treatment of obesity can lead to increased lifespan, particularly due to decreased risk of cardiovascular events and certain types of cancer, such as breast and colon cancers.
- Improved Metabolic Profile
If your weight has contributed to the onset of metabolic abnormalities like insulin sensitivity or abnormal lipid profiles, the results of bariatric surgery may just improve the severity of your conditions.
- Joint Pain Relief
With significant weight loss comes less strain on weight-bearing joints. Although we get used to carrying around extra weight, the reality is that our joints weren’t designed to bear such a heavy burden all the time. Reducing stress on the joints allows for more mobility and less pain.
- Healthier Sleeping Habits
Though it’s often underestimated, sleep is an extremely important part of health and healing. Conditions like sleep apnea can improve or stop altogether after bariatric surgery, leading to deeper, more restful sleep.
How Effective is Bariatric Surgery?
As numerous systematic review and meta analyses have demonstrated, Bariatric surgery is highly effective for the treatment of morbid obesity. Patients can usually expect to lose 50-80% of their excess body weight within 12 to 24 months of the procedure, with the most substantial drop in the first six months. This sudden decline may plateau at some point between one to two years post-surgery, but review and meta analysis reveal that at least half of patients maintain 50% or more of their excess weight loss after a decade.
While these outcomes are promising when it comes to reducing the global obesity epidemic, it’s important to note that long-term weight-loss will always depend on the patient. Both gastric sleeve and gastric bypass result in significant short-term weight-loss, but a patient’s commitment to lifelong changes in diet, physical activity, and mental health are determining factors in sustaining that loss. In the end, the vast majority of patients do enjoy considerable weight loss in the long term.
Who Should I Speak to About Bariatric Surgery?
If you still think bariatric surgery might be the solution for you, it’s time to book your consultation with a specialist. For experienced and understanding advice, Dr. Mikhail Y. Mastakov is renowned for his proficiency in a wide range of general surgeries, notably hernia and weight loss surgeries.
As an esteemed Fellow of the Royal Australasian College of Surgeons, Dr Mastakov brings to the table over 26 years of experience with a dedicated focus on bariatric surgery. He has enhanced his surgical skills through a preceptorship with leading Australian bariatric surgeons, and takes a patient-centric approach by ensuring clear communication and support before and after all procedures.
Currently practising at Mater Private Hospital in Redland, Sunnybank Private Hospital in Brisbane, and St Stephen’s Hospital in Hervey Bay, you can reach Dr Mastakov’s team on 07 3414 3950 for appointments, or use the online form to send an email.