Created on 05th March 2009
Once it seemed that a strict regime of dieting and exercise was the only way to lose those excess stones, it now appears that the diets have been dropped in favour of weight loss surgery as a way of dealing with obesity. Caroline Tustain investigates the different options
With celebrities such as Fern Britton, Sharon Osbourne and Roseanne Barr seemingly shedding stones and inches overnight, the results of weight loss surgery appear to speak for themselves. But it's not just the rich and famous who are opting for surgery.
Expert in the field Professor Nadey Hakim, bariatric surgeon for Court House Clinics and consultant surgeon and surgical director of the Transplant Unit of St Mary's Hospital in London, said, "According to the WHO (World Health Organisation), obesity has surpassed malnutrition as a global concern. Celebrities undergoing weight loss surgery make people aware of the existence of this type of surgery and that can only help."
In fact, the WHO predicts that by 2015, around 2.3 billion adults globally will be overweight, and more than 700 million will be obese. So what procedures are available, and who are they suitable for? Although they may sound like miracle cures, all surgeries need varying levels of commitment and work from the client. To make any weight loss procedure a success, lifestyle changes such as exercising regularly, giving up smoking, and eating a healthy diet should be followed.
Gastric band surgery
The most common procedure is gastric band surgery (or 'lapband' surgery) which involves the stomach being divided into two parts by a silicone ring, with the smaller stomach 'pouch' at the top. Laparoscopic (keyhole) surgery is required to insert the inflatable band around the stomach, and saline solution is injected into an access port which connects to the tubing, allowing the band to be tightened or loosened. The smaller pouch at the top of the stomach means that less food is needed to make the patient feel full. The food then passes through to the other part of the stomach slowly, and from there continues as normal.
The surgery involves a short hospital stay (generally overnight) and recovery takes around two weeks. Clients then need to visit the hospital regularly to have the band adjusted, and follow a nutritional regime. The benefits of this procedure are that 50-60 per cent of excess weight is reportedly lost in five years - with most of the weight loss being in the first one or two years.
Intragastric balloon
Unlike the lapband procedure, this does not require general anaesthetic. No keyhole surgery is required as the balloon is placed and removed through the mouth (endoscopic procedure).
Dr John Mason, medical director of the National Obesity Surgery Centre and a consultant gastroenterologist at Trafford General Hospital in Manchester where he is also medical director, describes the procedure. "The gastric balloon is a non-invasive weight-loss procedure offering radical results without the risks associated with many other kinds of bariatric surgery. It is literally a small balloon which is inserted via the mouth and filled with saline once inside the stomach, creating the sensation of being full and preventing overeating.
"The balloon is left in place for a period of six months, during which time the patient revises their eating habits to ensure that the weight lost stays off. Results vary obviously but patients have lost as much as six stone in six months."
It would seem that gastric balloons are becoming increasingly popular as the National Obesity Surgery Centre, which offers procedures at leading hospitals throughout England and Scotland, reported a 350 per cent increase in the number carried out last year (April to September 2008).
Dr Mason said, "There is also a broader market for the balloon, including those for whom the excess weight is more of a lifestyle issue than a medical concern. The new guidelines for gastric balloons recommend a minimum BMI of 27."
Gastric bypass surgery
For permanent weight loss, gastric bypass surgery is an option. However, as this is a major surgical procedure which cannot easily be reversed, it has greater risks of complications than gastric banding.
Similarly to gastric banding, an inflatable band is placed around the stomach, creating a small pouch at the top. A small section of the intestine is cut out making it shorter, and re-connected to the pouch. Whereas food filters into the larger section of the stomach with the lapband procedure, with the gastric bypass the food bypasses the rest of the stomach and is less easily absorbed by the body.
This operation can be carried out using keyhole surgery or open surgery. Candidates for this surgery generally have a BMI of 40 or over (morbidly obese), or of 35 and over with co-morbid conditions (such as diabetes and heart disease).
Sleeve gastrectomy
This involves removing around three-quarters of the stomach (divided vertically). As digestion stays the same, the function of the stomach does not change, and so reduces the risks of complications. As the stomach is smaller, patients feel full on smaller amounts of food, and can sometimes lose enough weight with this surgery. In some cases, however, a gastric bypass will later be performed (particularly for those with a high BMI, where the bypass surgery is not recommended without first losing weight).
Living with weight loss surgery
All surgeries carry with them varying degrees of risks and patients should be fully aware of them before undergoing any procedure. Post surgery diets vary from surgeon to surgeon, but often start with a liquid diet, followed by a blended or pureed sugarfree diet. Overeating may cause nausea and vomiting, and some patients will need to take a multivitamin pill every day for life.
Risks can include bloodclots, lung problems, deep vein thrombosis and infection.
Professor Hakim says, "Bariatric surgery is not to be taken lightly. The patient should be knowledgeable about the type of surgery he or she is asking for. The procedure must be done by an experienced surgeon who is properly trained. The more experienced the better. The procedure is not without risk and therefore the surgeon should be able to detect and deal with any potential complication."
