Obesity is a state where the body accumulates excess fat to the extent that the person’s health is affected. Based on the World Health Organisation’s (WHO) classification, a person with Body Mass Index (BMI) of more than 30 is considered obese. Physically, obesity causes conditions that affect the functioning of all major body systems. It also affects a person’s mental health and psychosocial wellbeing. Patients with obesity tend to have a shorter life expectancy of compared to a patient with normal body weight and BMI.
For patients with a much higher BMI, interventions like diet modification, exercise therapy and lifestyle modifications are less effective in achieving and maintaining long-term weight loss. Bariatric or metabolic surgery can be performed on the digestive system to help patients lose weight and improve medical conditions linked to obesity such as Type 2 Diabetes and Obstructive Sleep Apnoea (OSA).
Based on the guidelines issued by the Ministry of Health (MOH), patients can be offered bariatric surgery if they have:
An experienced team of medical professionals will assess the patient for suitability before he or she undergoes surgery.
Bariatric surgery works by reducing the functioning capacity of the stomach, which results in a reduction in caloric intake. Bariatric surgery may also involve the reconfiguration of the anatomy of the stomach and small intestine. This can result in a change in the hormonal signalling between the digestive and the brain, as well as the body’s basal metabolism rate (the rate at which the body burns calories at rest). These mechanisms result in effective and sustainable weight loss after surgery.
We can generally expect a loss of about 25% to 30% of the patient’s total body weight after bariatric surgery and this effect is usually consistent in the first three to five years after surgery. To sustain the weight loss in the long term after surgery, the patient will need to adopt behavioural changes like healthy dietary choices, mindful eating habits, consistent exercise, as well as healthy strategies of coping with stress. The support from an experienced multi-disciplinary team of medical professionals during the patient’s entire bariatric surgery journey can help to improve the chances of long-term successful weight loss.
Patients typically stay in hospital for one to three days after surgery. The use of minimally invasive (keyhole) surgical techniques for bariatric surgery causes less pain and surgical stress to the patient, and allows for faster recovery. Most patients are able to return to work in about two to four weeks, especially if their work does not involve heavy physical activity.
Immediately after surgery, patients will be placed on a special diet plan detailed by the bariatric surgery team. There is a gradual progression from a liquid-only diet, to soft foods and then finally back to solids. This adjustment period typically takes about six to eight weeks. During this time, patient should take sips of fluid regularly throughout the day to stay hydrated.
In the first six to eight weeks after surgery, patients should also start doing some light exercises like brisk walking, as recommended by the doctor. Exercises that are more intensive like running, cycling, resistance training and weight training should be deferred until the wounds heal completely and the patient is comfortable with eating and drinking regularly with the changes brought about by the surgery.
The most obvious change in the long term after surgery is that patients will be able to feel full much faster from eating a drastically reduced amount of food. This usually amounts to about four to five tablespoons of solid food every meal. Patients should maintain a balanced diet and prioritise taking proteins over other food types to maintain muscle mass during the period of weight loss. To maintain healthy bodily functions, all patients will have to take vitamin supplements regularly after surgery as well.
The change in the shape of the stomach will compel patients to chew every mouthful of food completely, and slow down between every mouthful of food. On top of this, the patient should avoid drinking about 30 minutes before and after meals, as the stomach may not have the capacity to accommodate both solid food and fluids together.
With successful weight loss and better health, patients typically feel more energetic, have less joint pain and are more confident in themselves. There is usually greater enthusiasm for doing things they have not done or were not able to do previously.
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