Weight Loss Surgery. Should You Or Shouldn’t You?

Being Australian used to be synonymous with athletic bodies. But that’s changed dramatically with Australia now listed as the fifth fattest developed nation in the world.

Data from 2018 show that a staggering 2/3 of Australian women and 3/4 of Australian men are now classed as overweight or obese. Overweight and obesity  causes more than half the diabetes cases in Australia, nearly half the arthritis burden and a quarter of the cases of heart diseases. With these alarming rates of unhealthy weight, weight loss surgery in countries like Australia, the UK and the US has more than doubled in the last decade and a half. And 79% of these procedures were done on women. 

What are the 3 types of bariatric surgery?

1. Laparoscopic Band Surgery

This procedure involves looping a band made of silicone around the upper part of the stomach. The silicone band is attached to a small tube through which it is inflated through a port with saline to tighten it. This has the effect of slowing down the entry of food into the main part of the stomach. As a result, the person feels fuller quicker. The pressure from the band also triggers nerves in the stomach to communicate with the satiety centre in the brain, telling your brain that you are full. The port is stitched beneath the abdominal skin so that it can be accessed easily with a needle if the saline levels need to be adjusted. When a band is first put in place, it may take a few weeks to get the level of tightness just right. One of the main problems that can occur in the long term, in up to 15% of people who have this surgery, is over-stretching of the oesophagus. When this happens the muscles of the oesophagus can’t function properly to propel food down towards the stomach causing symptoms like severe reflux, the feeling of food getting stuck, regurgitation, belching, chest discomfort, coughing and even pneumonia from food going down the wrong way and into the lungs (aspiration).

The lap band is the least effective procedure for weight loss with the highest rates of regaining weight. Because of the potential complications for a procedure that has a high failure rate of up to 70% in the long term, this procedure has lost popularity in recent years.

2. Sleeve Gastrectomy

Sleeve gastrectomy is a surgical procedure where part of the stomach is removed.

Weight loss from this surgery occurs in three ways:

  1. The remaining stomach portion is much smaller and can physically hold only limited volumes of food. As a result, less calories are consumed.
  2. The part of the stomach removed is also the part the that is most dense in P/D1 cells. These are the cells that produce ghrelin, the hunger hormone.  When your stomach is empty, the P/D1 cells are triggered to secrete ghrelin which signals to your brain that you are hungry and need to eat. When the stomach is full, the stretching of the stomach fibres suppresses the release of ghrelin. The absence of ghrelin producing cells following bariatric surgery means hunger sensations arising from the stomach are greatly reduced.
  3. People who undergo sleeve gastrectomy have been found to have increased levels of leptin. Leptin is known as the satiety hormone. It is produced in the brain and high levels signal to the brain that we are full and do not need to eat, whilst low levels stimulate hunger.

Problems that can occur after a sleeve gastrectomy include:

  • Hernias
  • Reflux
  • Low blood sugar
  • Vomiting
  • Abdominal pain
  • Constipation
  • Malnutrition

3. Roux-en-Y Gastric Bypass

This procedure involves making a very small pouch out of the top part of the stomach, sealing off the rest of the stomach, and then re-routing the small bowel to connect directly to the pouch, effectively bypassing the stomach. Weight loss from this procedure happens through inability to consume large amounts of calories and through less ghrelin production. As a result, despite eating less, hunger is greatly reduced and there is an increased sense of satiety.

Should you or shouldn’t you?

The decision to undergo weight loss surgery is not one to be taken lightly and should be made in consultation with your doctor and family. 

Food behaviours and mental health are a major consideration before embarking on this journey. Up to a third of people who go through these major procedures don’t reach their weight loss goals and nearly 5% of people have a second procedure done due to regaining weight. The main reason for this is insufficient changes in behaviours around food.  Massive changes to body weight, shape and size in a short period of time can also trigger mental health problems including eating disorders, anxiety, personality disorders, alcohol excess and marital problems.

Rapid weight loss in the first few months after surgery can cause:

  • Mood changes
  • Hair thinning and hair loss
  • Dry skin
  • Loss of energy
  • Feeling cold
  • Aches and pains all over the body
  • Feeling ‘flu-like’

Malnutrition can happen after sleeve gastrectomy and gastric bypass due to poor absorption of nutrients. It is recommended that after these surgeries multi-vitamins are taken for life. 

Supplements should include:

  • Vitamin B1 
  • Vitamin B12 
  • Folic acid
  • Iron
  • Vitamin D and calcium
  • Zinc
  • Copper

One of the frequently overlooked longterm complications of bariatric surgery is osteoporosis. Due to poor calcium and vitamin D absorption, bone thinning occurs over time. People who have these operations should have bone density scans performed every 2 years to monitor bone strength. But data shows that this is actually only happening in about 10% of cases.  

What we all know is that gaining weight is so much easier than losing it. And 90% of the reason we are the weight we are is down to the food we eat. So, the best place to start is with education about diet and nutrition. Small changes can have an incremental effect that overtime transforms your wellbeing.

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