A gentler approach to weight loss surgery

We are told by health professionals on a regular basis that a good diet and regular exercise program are the cornerstone of good health. But what about those of us who struggle with staying on track and have battled weight fluctuations because of the pressures of life? Pregnancy, stress, injury or disability and genetic disposition can all contribute to a higher BMI over the years.

“While using medications to suppress appetite can work for short-term weight loss, they don’t reverse that set point. To stay at the set point you’d need to be on them for life, otherwise you will regain the weight. Surgery is more effective because it deals with the cause of the weight gain – your hormones,” says bariatric surgeon Dr Mark Magdy.

Bariatric surgery can be medically recommended for a number of reasons, including co-occurring obesity (BMI greater than 30) with chronic health concerns such as high blood pressure, diabetes, insulin resistance and sleep apnoea. People with BMIs greater than 35 can receive a direct recommendation for surgery, however there is differing advice for different social groups.

“These groups can include the patients who have struggled with their weight, engaging in yo-yo dieting with little long-term results; or people undergoing procedures such as joint replacement or hernia operations which require a lower BMI for optimal success.”

Types of bariatric surgery

All bariatric surgery is done with the goal of resetting a patient’s set point to healthy parameters: by decreasing the amount of calories consumed; changing the gut hormones in such a way that favour weight loss; and synthesizing optimal insulin levels. Depending on the starting points of these factors, different procedures are performed.

The sleeve gastrectomy is the most commonly performed. It is a permanent procedure where a portion of the stomach is removed and discarded. The mechanism for releasing the hormone which creates hunger (ghrelin) is also removed.

Bypass procedures including roux-en-y and one anastomosis gastric bypass involve creating a small stomach pouch and then re-routing food directly to the small intestine; and loop duodenal switch (or single anastomosis duodeno-ileal bypass – SADI) which combines a sleeve gastrectomy with a bypass, a powerful operation resulting in significant weight loss and improvement in obesity-related comorbidities.

The first three procedures are done under general anaesthetic using laparoscopic or robotic (keyhole) surgery.

A newer procedure uses the Allurion Balloon, suited to those with a BMI between 27 and 40. An anaesthetic-free, endoscopy-free swallowable capsule, and it’s performed in an x-ray department, where the surgeon can x-ray to confirm position. It is broken down after about four months, and passed naturally through the digestive system.

Any procedure involves risks or side-effects, and bariatric surgery deals with complications in the absorption of nutrients, meaning patients can develop mineral and vitamin deficiencies leading to the need for lifelong vitamin supplements or replacement. This is why bariatric surgery patients receive multidisciplinary after-support from psychologists, dietitians and exercise physiologists to ensure they are set up for a successful, healthy life following surgery.

“Once we gain weight, we have changed our body’s makeup,” says Dr Magdy. “Every study has shown that the more you diet, then the more your body works in such a way to make you hungrier, and your hormones will try to get you back to your set point. This is where surgery can help, by resetting that point.

“That’s going to result in a cancer risk reduction, and in most cases you can either completely cure or considerably improve a patient’s diabetes, blood pressure, sleep apnoea, exercise tolerance, fitness, and sleep quality, I could go on…” he says.