WITHOUT the WHITECOAT
Bariatric Surgery, answer to obesity
In the past years losing weight was very futile for some of us, from the daily intake of “Xenical” and “Reductril” to the some diet-modifying medications. All of these are to no avail. The weight stills stays on and worse of all we still gain more weight. Some had tried the fad diets developed in the United States as well as the low-fat-cholesterol-free and the “low-carbohydrate” diets but all of these seemed to be ineffective because in the end the weight still stays on. The excess fat and skin still hangs on our beautiful figure.
It seems that the central obesity is getting hard to measure. Looking at the mirror, we can see a “Jabba the Hut” in some sort. For an obese person, the psychological effects of losing weight is a big nightmare.
For a short “depression” in which all modalities proved to be a big failure, we realized that diets and interventions are all “ yo-yo” in nature. Oftentimes, we count on our “will power” to lose weight. But then it is hard to keep it up since “will power” sometimes breaks down and then there goes the bathroom scales hitting the ceilings.
In some desperation, a dental procedure like having dental retainers, which are put in place and then “locked”, may help a lot. It minimizes the intake of all the nutritious, palatable and sumptuous meal… or in short gluttony. It maybe the glutton in all of us that makes it hard to stay on a diet and to stick on a certain program with a nutritionist in hand.
Once all the medical problems arises from obesity ( co-morbidities), then the will to survive is much more greater to be attained than having a “piece” of that “ sumptuous” suckling roasted pig on top of our dinning table. Hypertension, hyperlipidemia, osteoarthritis, chronic back pain, depression, venous stasis, diabetes mellitus, polycystic ovaries, irritable bowel syndrome, fatty liver(non-alcoholic), GERD (gastro-esophageal reflux disease), and colon cancer are just “some” of the obesity-related co-morbidities. We all tend to forget the worst side of this co-morbidities like ischemic stroke, for example, that can lead to some debilitating “states” or even worst - a cardiac arrest. It is only good if we recover. But what will happen if a “massive” myocardial infarction will lead us to that dreaded sign on our tombstone “ R.I.P.” or “ here lies a GLUTTON?
It is high time for us to wake up from that nightmare. We are all called with different names “FAT LARD”, “OBESE” ,”EXCESSIVELY FAT”, “BELBIL BOY”, “OVERWEIGHT”, “PORKY/MAMOY” and other more names synonymous with being obese. If the “yo-yo” diets and all of the “diet-modifying diets” fails, then a surgical intervention like “ Bariatric Surgery” is can be considered. We may not look on the health cost that obesity will bring but the nightmare on having all of the diseases such as coronary artery disease, diabetes, obstructive sleep apnea, osteoarthritis, chronic infections, and psychological disorders are the reasons why we must consider loosing all that excess fats ,pounds, and baggage.
As a family physician, the “front-liners” in medical practice, it is important to have the knowledge about the risk and the benefits of the procedure and to understand the complexities of a life-long medical surveillance that these patients require. Bariatric surgery leads to a sustainable long-term weight loss and thus will reduced obesity-related co-morbidities. There are two procedures in hand that are available as part of Bariatric surgery. The RYGB (roux-en-Y), a gastric by-pass which is commonly performed, has an advantage of providing restrictive and a malabsorptive component to induce weight loss. The second procedure is the VBG ( vertical banded gastroplasty). In VBG, a small stomach pouch is created with an outlet that lies along the lesser curvature of the stomach, thus resulting only the restrictive component of weight loss.
In addition to those mentioned, there is the newer one. The procedure is via laparoscopic surgery wherein an adjustable gastric band with an inflatable ring that can be adjusted through a subcutaneous access point is placed on the gatro-esophageal junction. The laparoscopic procedure of gastric banding looks very promising since it only involves small opening in the abdomen compared to the conventional type wherein the patient have to be opened up. Therefore, recovery rates are earlier and shorter resulting to lesser complications.
Here are some indications for Bariatric surgery(NHI): 1) BMI(body mass index) of 40 kg per m2 or higher/BMI of 35 kg per m2 or higher with serious obesity-related co-morbidities like diabetes, obstructive sleep apnea, coronary artery disease, and debilitating arthritis; 2) Previous failed weight loss attempts involving an integrated nonsurgical weight loss program including dietary modification, behavioral support, and appropriate exercise; 3) Possession of appropriate motivation and psychological stability to understand risks and the benefits of the procedure as well as the commitment to lifelong postoperative lifestyle changes and medical surveillance.
For those that have lived a human and mortal life who are still in the middle of nightmare soaking themselves in a “sea of LARD and FAT”, it is time to wake up and view this surgical procedures as an answer. Remember we are here to “enjoy” life, not just only the “glutinous or sumptuous” side of it. We should look forward to a life free of medications and complications from diabetes and coronary artery disease. A life full of lifestyle modifications coupled with a healthy diet should be attained to ensure us all of a life worth looking forward to. Bariatric surgery may answer all these obesity problems. Let us give it a chance to address our hard encounters in losing weight.