IF SYMPTOMS PERSIST
By DR. JOSE PUJALTE JR.
They are inclosed in their own fat”
The Holy Bible, Old Testament
If you’re obese and miserable and life seems to be just passing you by and if you’ve tried everything to lose weight and nothing worked, would you consider anything to lose weight?
Even surgery? If all diets have failed, exercise impossible or dangerous, and food has been a temptress forever, and you’re willing to undergo an operation, read on.
Bariatric Surgery. “Bariatric”comes from two Greek words, “bari” for “weight” and “atri” for “treatment of.” It is a branch of medicine that treats obese patients. What is “obese”? From just a weighing scale point of view, that’s usually 100 pounds past ideal weight in males or 80 pounds in females. But what is “ideal weight.” We can’t discuss this without bringing up “BMI” or “body mass index” a measure of the relationship between and person’s height and his mass in kg/m². A BMI of 18.5 to 25 is optimal weight; between 25-30 is overweight. Obesity has been re-classified into three classes Class I (moderately obese, BMI 30-35), Class II (severely obese, BMI 35-40), and Class III (very severely obese, BMI >40). Bariatric surgery is indicated for the severely obese with serious health problems like type II diabetes, heart disease, or sleep apnea and the very severely obese.
Four Operations. You must discuss with your doctor or surgeon the options available for you. Note that you must have failed in dieting and exercise and simply not just lazy for these approaches to weight loss. Look upon bariatric surgery as the LAST option. The first option is the adjustable gastric band (AGB) wound around the top of the stomach to decrease food intake. It can be inflated or deflated by the doctor as the weight changes. The second option is the Roux-en-Y gastric bypass (RYGB) which restricts food intake and decreases how food is absorbed. Food directly goes into the small intestine, bypassing the stomach. The third option is biliopancreatic diversion with duodenal switch (BPD-DS) which has three parts: removing part of the stomach (making it smaller), re-routing food away from the small intestine, limiting how it is absorbed, and finally a change in how bile and other digestive enzymes digest food and absorb calories. Lastly, in vertical sleeve gastrectomy (VSG), most of the stomach is removed.
Side Effects. Like any surgery, some things can go wrong. There may be uncontrolled bleeding, infection, and of course, leaks where the intestines are sewn together. There can be diarrhea and blood clots that form in the legs and thrown off to the lungs or heart (deep vein thrombosis). Because food will no longer be absorbed normally, the doctor will watch out for and replace nutrients and vitamins like niacin and thiamine.
Results. Long-term results published in the New England Journal of Medicine report that mortality rate after bariatric surgery goes down up to 40%. It can indeed by a life-saving intervention. There are further reports of better control of diabetes, heart disease, and other life-threatening conditions.
So, if you are a candidate, imagine your “before” and “after” pictures. Especially the “after” picture where you fit into one leg of a pair of old pants, grinning from ear to ear. If you’ve had enough of the fat and want to be your own biggest loser (of weight), this may be the way forward.
Dr. Pujalte is an orthopedic surgeon. email [email protected]