When would a specialist suggest a patient resorts to weight loss surgery?
“If a patient [with obesity] is young and [reasonably] fit and healthy, it’s best to first modify their lifestyle and diet, and increase their motivation,” Dr Oliver Florica, Bariatric Surgeon at Sydney Adventist Hospital said.
“However, if you have a comorbidity, often bariatric surgery is the first and safest option.
“For example, around half of bariatric surgery patients suffer from type 2 diabetes. You don’t want to be trying numerous diets over time only to get organ damage [as a complication of type 2 diabetes],” he said, referring to the joint statement by the International Diabetes Organisations: that due to its positive impact on glycaemic (blood sugar) levels, bariatric surgery is an effective treatment for type 2 diabetes in morbidly obese individuals.
There are three bariatric surgery options for reducing weight and maintaining weight loss, Dr Florica said.
- Lap band surgery involves placing an adjustable ring around the top of the stomach, which improves satiety and restricts food consumption.
- In a gastric bypass, a small gastric pouch diverts into a more distal part of the bowel, altering digestion and absorption of food.
- In gastric sleeve surgery, a large part of the stomach is removed.
“Firstly we need the patient to psychologically understand the surgery is not a quick fix, but a tool,” Dr Florica said.
“They have to show they are making an effort to change their lifestyle and diet and understand the procedure requires motivation and vigorous follow-up that’s often lifelong.”
A comprehensive routine blood test and cardiovascular assessment also ensures the patient is fit for surgery.
“In the surgery leadup, we advise them to give up sweet drinks, [refined] carbohydrates and [other sources of] empty calories, and to focus on a protein-rich diet.” Alcohol and smoking are off-limits.
“Two weeks before surgery, we put the patient on a very low-calorie meal replacement diet…Patients are very compliant when this is only for two weeks, and it results in a weight loss of as much as 10 to 15 kilos.”
Recovery, and keeping the weight off
“Bariatric surgery is a keyhole procedure, so isn’t as invasive as people often think,” Dr Florica said.
“Patients [have] minimal discomfort and go home one to two days after surgery. Two to three days after surgery they can drive, and a week later they can do light exercise. Return to work is often a week to two weeks post-surgery.”
Weight loss motivation comes naturally due to the four to five kilo weight loss in the first week or two after surgery.
“Some patients need nutritional supplements, however others adapt so well that these aren’t required.”
Follow-up appointments, including counselling every four to six weeks encourage the patient to comply with the prescribed diet (Dr Florica’s medical partner specialises in psychological counselling).
“We inform the patient of the risks of not complying, such as inadequate weight loss and adverse symptoms. Fortunately the surgery is not flimsy, so if you ‘cheat’ once or twice it will not fall apart.” Dr Florica refers patients with more complex psychological or psychiatrist issues to their own psychologist and psychiatrist.
“I tell my patients it’s not an easy way out, it’s a hard way out,” he said. “The surgery is a commitment, not a diet you can start and stop as you please.”
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