18 July 2018

By Dr Malik Feisal Ayob- General, Metabolic and GI Surgery.

Excess weight loss can cause serious health problems. The health problems associated with obesity are as below:

1. Metabolic disorders (Diabetis Mellitus, Hypertension, High cholesterol in the blood, Gout).
2. Fatty liver
3. Gallbladder stone.
4. Heart disease.
5. Hormonal imbalance particularly in women.
6. Joints and bones diseases
7. Skin diseases.
8. Impairment in wound healing.
9. Stroke.
10. Sleep apnoea.
11. Various cancers.


When you are obese, your overall quality of life may be lower and hence affecting your performance in carrying out daily activities. Other issues that may affect your quality of life include:

1. Depression
2. Physical disability and discomfort
3. Sexual problems
4. Shame
5. Social isolation


Eating right and exercises are the best way to maintain weight as well as to lose weight. However, only a very small percentage of people succeeded due to various reasons like non-committal to the advised diet regimes, food cravings, peers pressure and lack of education and information to the very least. Modifying one habit is not an easy task for excessive eating in majority of cases is habitual. Many have incorporated drugs therapy, psychotherapy and hypnotherapy only to be frustrated by the results. The desire for many to lose weight through short cut measures has resulted to the weight loss drugs industries blooming, in which many are not registered approved by the local food and drugs authority and many too are proven to have detrimental effects to ones’ health. Studies have shown that less than 5% of obese individuals have succeeded with conservative therapy 1.


Weight loss or bariatric surgery is a good option for individuals who are obese especially for those with obesity related health problems.


The surgery promotes weight loss and in many cases corrects metabolic disorders 2. Recent studies have proven that the surgery have a favorable impact on the death rates in severely obese patients 3. The best results are achieved when the surgery is followed by modification of eating behavior to health favorable behavior and exercises. There are various forms of the surgery and it is tailor made to the individuals after considering the risks and benefits. The various forms include restrictive procedure, and combination of both restrictive and absorptive limiting procedure.


Weight loss surgery in our hospital is done by laparoscopic approach. It requires only 4 to 5 small cuts (5 to 12 mm) to get the access into the abdominal cavity. This provides less tissue damages and early recovery. However not all patients are suitable for laparoscopic surgery. History of previous abdominal surgery, patients with compensated respiratory functions may require the traditional “open” approach. In restrictive procedure, weight loss is achieved by restricting food intake. Restricting food intake combine with post-surgery dietary modification of reducing sugar and salt intake will more often than not improves sugar control in type 2 diabetis 4 and also improves blood pressure 5. The common and widely accepted restrictive surgery is the sleeve gastrectomy(fig.1).

The stomach is cut reducing the volume to about 10 to 20 percent of the original volume. Removing 80 to 90 percent of the stomach includes removal of the gastric fundus which houses the majority of glands that secretes the hormones Ghrelin’s which is also known as the hunger hormones. Not only there is reduction in stomach capacity, but is also reducing hunger.


In the restrictive and absorptive procedure, there are many varieties but in our hospital we are adapt to the Gastric Bypass surgery (fig.2).

For the Gastric Bypass surgery, the stomach volume is reduced to about 10 percent and about 150 to 200cm of the proximal small intestine where 90 percent of nutrients absorption takes place is bypassed. The bypassing results is drastic reduction in the absorption of sugar,salt,fat and many other nutrients. This procedure has been proven to be effective in morbidly obese individuals who already have metabolic diseases 6. The drawbacks here are the loss of important nutrients which may have to be replaced by intravenous administration at regular intervals after the surgery.


Rates of obesity among adolescent are significantly on the rise. They are more often already accompanied by some metabolic disorder. It is clear that weight loss surgery can help them to lose weight but there are numerous unanswered questions about the long term effects on their developing bodies and minds. Experts in paediatric obesity and weight loss surgeries have recommended that surgical treatment is to be considered only for the morbidly obese in which 6 months of conservative therapy has been futile. Candidates should also have reached their adult heights.


Patients who have undergone the surgery is expected to experience rapid weight loss in the first 6 months. Most studies have shown that weight loss in this period is between 20% to 30% of the total body weight. Then after, the rate will decline but still achieving weight loss8. The metabolic disease in most cases is resolved if not well controlled.




REFERENCES: 1. Adams TD, Pendleton RC, Strong MB, Kolotkin RL, Walker JM, Litwin SE, Berjaoui WK, LaMonte MJ, Cloward TV, Avelar E, Owan TE, Nuttall RT, Gress RE, Crosby RD, Hopkins PN, Brinton EA, Rosamond WD, Wiebke GA, Yanowitz FG, Farney RJ, Halverson RC, Simper SC, Smith SC, Hunt SC. Health outcomes of gastric bypass patients compared to nonsurgical, nonintervened severely obese. Obesity (Silver Spring). 2010 Jan;18(1):121-30. doi: 10.1038/oby.2009.178. 2. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2017 Jan;30 Suppl 1:S42-7. 3. Anderwald CH, Tura A, Promintzer-Schifferl M, Prager G, Stadler M, Ludvik B, Esterbauer H, Bischof MG, Luger A, Pacini G, Krebs M. Alterations in gastrointestinal, endocrine, and metabolic processes after bariatric Roux-en-Y gastric bypass surgery. Diabetes Care. 2012 Dec;35(12):2580-7. doi: 10.2337/dc12-0197.. 4. Arterburn DE, Bogart A, Sherwood NE, Sidney S, Coleman KJ, Haneuse S, O’Connor PJ, Theis MK, Campos GM, McCulloch D, Selby J. A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass. Obes Surg. 2013 Jan;23(1):93-102. doi: 10.1007/s11695-012-0802-1. 5. ASMBS Clinical Issues Committee. Bariatric surgery in class I obesity (body mass index 30-35 kg/m²). Surg Obes Relat Dis. 2013 JanFeb;9(1):e1-10. doi: 10.1016/j.soard.2012.09.002. 6. Bays HE, Chapman RH, Grandy S; SHIELD Investigators’ Group. The relationship of body mass index to diabetes mellitus, hypertension and dyslipidaemia: comparison of data from two national surveys. Int J Clin Pract 2007;61(5):737-47. 7. Bradley D, Conte C, Mittendorfer B, Eagon JC, Varela JE, Fabbrini E, Gastaldelli A, Chambers KT, Su X, Okunade A, Patterson BW, Klein S. Gastric bypass and banding equally improve insulin sensitivity and β cell function. J Clin Invest. 2012 Dec;122(12):4667-74. doi: 10.1172/JCI64895. 8. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004 Oct 13;292(14):1724-37.




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